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Significance of Corticosteroids and Their Relationship with Other Parameters in Patients with Sepsis  

Lee, Keu Sung (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine)
Baik, Seung Hee (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine)
Lee, Hyoung No (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine)
Park, Joo Hun (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine)
Oh, Yoon Jung (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine)
Sheen, Seung Soo (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine)
Choi, Young Hwa (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine)
Park, Kwang Joo (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine)
Hwang, Sung Chul (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine)
Publication Information
Tuberculosis and Respiratory Diseases / v.61, no.4, 2006 , pp. 356-365 More about this Journal
Abstract
Background: 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 ($250{\mu}g$) 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.
Keywords
Sepsis; Corticosteroids; Cortisol; Relative adrenal insufficiency; Prognosis; Severity;
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