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Cortisol Testing in Septic Shock: An Evaluation of Diagnostic Performance and Predictors of Corticosteroid Use in a

Fayez Alshamsi1, Saeed Alkaabi1, Maryam Nasser Mohamedali Alfadli1

  • 1Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates.

Diagnostics (Basel, Switzerland)
|October 29, 2025
PubMed

Insights

Baseline total cortisol levels showed poor accuracy in diagnosing critical illness-related corticosteroid insufficiency (CIRCI) in septic shock patients. Clinical judgment, not cortisol testing, is crucial for guiding corticosteroid therapy in this population.

Area of Science:

  • Critical care medicine
  • Endocrinology
  • Sepsis research

Background:

  • Diagnosis of critical illness-related corticosteroid insufficiency (CIRCI) is challenging due to sepsis pathophysiology.
  • International guidelines now favor clinical evaluation over strict cortisol thresholds for adrenal insufficiency.
  • Applicability of revised diagnostic approaches in non-Western populations is unknown.

Purpose of the Study:

  • To assess the diagnostic accuracy and clinical utility of baseline total cortisol levels.
  • To guide corticosteroid therapy in intensive care unit (ICU) patients with septic shock in the UAE.
  • To evaluate cortisol's role in a non-Western cohort.

Main Methods:

  • Retrospective observational study of ICU patients with septic shock (2012-2022).
  • CIRCI defined by clinical decision to administer hydrocortisone >24 hours.
  • Receiver Operating Characteristic (ROC) and Decision Curve Analysis (DCA) used.

Main Results:

  • 13 of 43 patients (30.2%) received hydrocortisone; mean cortisol was higher in this group (p=0.24).
  • ROC analysis showed poor diagnostic performance (AUC 0.61); guideline cutoff had 0% sensitivity.
  • Clinical factors (vasopressor use, shock duration) predicted therapy; cortisol levels did not.

Conclusions:

  • Baseline total cortisol has poor diagnostic accuracy and lacks clinical utility in guiding corticosteroid therapy for septic shock.
  • Clinical judgment is paramount for identifying patients requiring corticosteroid therapy, aligning with international guidelines.
  • Findings emphasize reliance on clinical assessment over biochemical markers in this cohort.

Keywords:
clinical utilitycortisolcritical illness-related corticosteroid insufficiencydiagnostic accuracyhydrocortisoneintensive caresepsisseptic shock

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