Tuberc Respir Dis > Volume 61(4); 2006 > Article
Tuberculosis and Respiratory Diseases 2006;61(4):356-365.
DOI:    Published online October 1, 2006.
Significance of Corticosteroids and Their Relationship with Other Parameters in Patients with Sepsis.
Keu Sung Lee, Seung Hee Baik, Hyoung No Lee, Joo Hun Park, Yoon Jung Oh, Seung Soo Sheen, Young Hwa Choi, Kwang Joo Park, Sung Chul Hwang
Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine, Suwon, Korea.
Corticosteroids are known to be significant prognostic parameters in sepsis. Recently, an absolute and relative insufficiency of the corticosteroids system has often been reported to often develop particularly in severe sepsis. Degree of such an adrenal insufficiency not only has prognostic implications but also can be used to guide corticosteroids replacement therapy. The 24-hour urinary cortisol levels as well as serum cortisol concentrations were measured to assess the clinical significance and their relationship with the other parameters of sepsis, and also evaluated the clinical implications of the relative adrenal insufficiency. METHODS: 26 consecutive patients with sepsis were enrolled. The basal random serum cortisol, ACTH, ADH, lactate levels and 24-hour urinary free cortisol amount were measured. The rapid ACTH (250 microgram) stimulation test was also performed. RESULTS: Basal serum cortisol levels were higher in the non-survivors than in the survivors. The 24-hour urinary free cortisol levels were higher in the patients with severe sepsis than in those without. The serum cortisol levels strongly correlated with the serum ADH and lactate levels. The 24-hour urinary free cortisol levels strongly correlated with the serum cortisol and lactate levels. The fractional changes in the cortisol levels after the rapid ACTH stimulation tests correlated with the serum cortisol, ADH, and lactate levels. CONCLUSION: Both the serum cortisol and 24-hour urinary cortisol were found to be significant prognostic factors in sepsis, and showed a strong correlation with the other parameters. The relative adrenal insufficiency might also be an important clinical parameter.
Key Words: Sepsis, Corticosteroids, Cortisol, Relative adrenal insufficiency, Prognosis, Severity

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