Bollaert Pierre-Edouard, Fieux Fabienne, Charpentier Claire, Lévy Bruno
Department of Medical Intensive Care Unit, Nancy University Hospital, 54035 Nancy, France.
Shock. 2003 Jan;19(1):13-5. doi: 10.1097/00024382-200301000-00003.
The prognostic value of basal and corticotropin-stimulated cortisol concentration in patients with sepsis remains a controversial issue. In a retrospective cohort study, 82 consecutive patients with septic shock underwent a short corticotropin test performed more than 24 h after the onset of vasopressor therapy. Forty-one (50%) patients died within 28 days after the onset of septic shock. The mean (SD) basal cortisol level was 22.7 (10.6) microg/dL. With threshold values of 7 and 9 microg/dL maximal increases in cortisol level, 28 (34%) and 31 (38%) patients were, respectively, classified as nonresponders to the short corticotropin test. On multivariate analysis, a cortisol level >20 microg/dL (P = 0.0002), a maximal response to corticotropin <9 microg/dL (P = 0.044), abnormal lactate values (P = 0.0098), and positive blood cultures (P = 0.004) were independent predictors of 28-day mortality. In conclusion, high basal cortisol and low increase on corticotropin stimulation are predictors of a poor outcome in late septic shock. The underlying mechanisms of these prognostic patterns remain to be elucidated.
脓毒症患者基础及促肾上腺皮质激素刺激后的皮质醇浓度的预后价值仍是一个有争议的问题。在一项回顾性队列研究中，82例连续性感染性休克患者在血管升压药治疗开始24小时后接受了促肾上腺皮质激素短试验。41例（50%）患者在感染性休克发作后28天内死亡。基础皮质醇水平的均值（标准差）为22.7（10.6）μg/dL。皮质醇水平最大增幅的阈值分别为7μg/dL和9μg/dL时，分别有28例（34%）和31例（38%）患者被归类为促肾上腺皮质激素短试验无反应者。多因素分析显示，皮质醇水平>20μg/dL（P = 0.0002）、促肾上腺皮质激素最大反应<9μg/dL（P = 0.044）、乳酸值异常（P = 0.0098）及血培养阳性（P = 0.004）是28天死亡率的独立预测因素。总之，基础皮质醇水平高及促肾上腺皮质激素刺激后增幅低是晚期感染性休克预后不良的预测因素。这些预后模式的潜在机制仍有待阐明。
