Yildiz Orhan, Tanriverdi Fatih, Simsek Serap, Aygen Bilgehan, Kelestimur Fahrettin
Associate Professor, Department of Infectious Diseases, School of Medicine, Erciyes University, Kayseri, Turkey.
J Res Med Sci. 2011 Nov;16(11):1410-21.
Despite the new developments in sepsis treatment, mortality rate is still high. In this study, we aimed to investigate endocrinologic changes and the effects of moderate dosage steroid treatment in patients with sepsis.
Fifty-five patients were included in the study. Basal hormonal evaluation and adrenocorticotropin hormone (ACTH) stimulation test were performed within 24 h in all patients. Both groups received standard treatment for sepsis. However, one group (steroid group) was also given intravenous prednisolone (20 mg/day). All-cause mortality was assessed during the first 28 days.
Analysis of the findings revealed a 59.3% mortality rate in steroid group compared with a 53.6% mortality rate in placebo group (p = 0.787). Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, and peak cortisol and ACTH levels were significant factors related to mortality. The incidence of adrenal insufficiency (AI) was 10.9% and relative adrenal insufficiency (RAI) 36.4%. It was also found that steroid treatment did not have any effects on the mortality of patients with AI and RAI (p = 0.075 and p = 0.999, respectively).
Moderate-dose steroid therapy has no effect on mortality. Higher basal cortisol and peak cortisol levels were found more reliable mortality indicators compared to RAI. In addition, the study revealed that ACTH level was a significant indicator of mortality.
尽管脓毒症治疗有新进展，但死亡率仍然很高。在本研究中，我们旨在调查脓毒症患者的内分泌变化以及中等剂量类固醇治疗的效果。
55例患者纳入本研究。所有患者均在24小时内进行基础激素评估和促肾上腺皮质激素（ACTH）刺激试验。两组均接受脓毒症的标准治疗。然而，一组（类固醇组）还静脉注射泼尼松龙（20毫克/天）。评估前28天内的全因死亡率。
结果分析显示，类固醇组死亡率为59.3%，而安慰剂组为53.6%（p = 0.787）。急性生理与慢性健康状况评分系统（APACHE）II和序贯器官衰竭评估（SOFA）评分，以及皮质醇峰值和ACTH水平是与死亡率相关的重要因素。肾上腺功能不全（AI）发生率为10.9%，相对肾上腺功能不全（RAI）为36.4%。还发现类固醇治疗对AI和RAI患者的死亡率没有任何影响（分别为p = 0.075和p = 0.999）。
中等剂量类固醇治疗对死亡率无影响。与RAI相比，基础皮质醇水平较高和皮质醇峰值水平被发现是更可靠的死亡率指标。此外，研究表明ACTH水平是死亡率的一个重要指标。
