Higher Serum Cortisol is Associated with Delayed Shock Resolution in Septic Shock Patients

Area of Science:

• Critical Care Medicine
• Endocrinology
• Sepsis Research

Background:

• Elevated serum cortisol is linked to mortality in septic shock.
• The relationship between cortisol and hemodynamic recovery in septic shock requires further investigation.

Purpose of the Study:

• To investigate the association between initial serum cortisol levels and hemodynamic recovery, specifically shock reversal, in adult patients with septic shock.

Main Methods:

• Prospective cohort study involving 81 adult septic shock patients.
• Serum cortisol, SOFA, and APACHE III scores were measured at diagnosis.
• Shock reversal defined as vasopressor discontinuation for 24 hours with MAP ≥ 65 mmHg.

Main Results:

• Higher serum cortisol levels independently predicted a lower probability of shock reversal at 72 hours (HR per 1 µg/dL increase: 0.95).
• Elevated cortisol was associated with reduced likelihood of early shock control at 6 hours (HR: 0.96).
• Cortisol levels > 30 µg/dL showed substantially lower probabilities of 72-h shock reversal (HR: 0.17).

Conclusions:

• Initial elevated serum cortisol levels in septic shock independently predict delayed shock reversal and poorer early shock control.
• No significant association was found between elevated cortisol and 28-day mortality.