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Total and high-affinity corticosteroid-binding globulin depletion in septic shock is associated with mortality

Emily J Meyer1,2, Marni A Nenke1,2, Wayne Rankin1,2,3

  • 1Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Clinical Endocrinology
|August 31, 2018
PubMed

Insights

Low levels of high-affinity corticosteroid-binding globulin (haCBG) correlate with mortality in septic shock patients. This suggests haCBG plays a key role in delivering cortisol during sepsis.

Area of Science:

  • Endocrinology
  • Critical Care Medicine
  • Immunology

Background:

  • Corticosteroid-binding globulin (CBG) and albumin transport cortisol.
  • Cleavage of high-affinity CBG (haCBG) by neutrophil elastase releases cortisol at inflammatory sites, aiding immunomodulatory effects.

Purpose of the Study:

  • To investigate the association between high-affinity CBG (haCBG) depletion and mortality in patients with septic shock.

Main Methods:

  • A prospective observational cohort study involving 30 septic shock and 42 nonseptic critical illness patients.
  • Serum samples were collected over 72 hours to assay total and haCBG, and total and free cortisol.
  • Mortality was assessed at 28 days, with glucocorticoid treatment as an exclusion criterion.

Main Results:

  • Septic shock patients exhibited lower total CBG, haCBG, and low-affinity CBG (laCBG) compared to controls.
  • Significantly lower total CBG and haCBG levels were observed in septic shock patients who died versus survivors.
  • While free cortisol fractions were higher in those with low haCBG, cortisol levels themselves did not correlate with mortality.

Conclusions:

  • Reduced circulating haCBG concentrations are linked to increased mortality in septic shock.
  • These findings support a crucial physiological role for haCBG in cortisol delivery to tissues during septic shock.
Abstract

Keywords:
CBGcorticosteroid-binding globulincortisolmortalityseptic shock

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