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Prognostic Classification of Patients with Septic Shock Based on Cortisol Levels and Cortisol Response to Corticotropin

Purpose: Purpose: To use cortisol levels before and after corticotropin stimulation to identify patients with septic shock at high risk for short-term mortality.

Description

Annane et al studied the effect of stress from septic shock on the hypothalamic-pituitary-adrenal axis. They found that the pattern of serum cortisol levels before and after corticotropin stimulation could identify patients with septic shock who were at high risk for death. These patients might benefit from more aggressive or novel therapies.


Short corticotropin stimulation test:

(1) 0.25 mg tetracosactrin (corticotropin) injected intravenously

(2) blood samples were collected just before the injection (baseline), at 30 minutes after injection, and at 60 minutes after injection.

 

maximum cortisol level in µg/dL =

= MAX(serum cortisol at 30 minutes in µg/dL, serum cortisol at 60 minutes in µg/dL)

 

change in peak cortisol from baseline levels =

= (maximum cortisol level in µg/dL) – (baseline cortisol level in µg/dL)

 

 

Baseline Cortisol

Change in Peak Cortisol from Baseline Levels in Response to Corticotropin

Prognostic Group

<= 34 µg/dL

>  9 µg/dL

good

<= 34 µg/dL

<= 9 µg/dL

intermediate

> 34 µg/dL

> 9 µg/dL

intermediate

> 34 µg/dL

<= 9 µg/dL

poor

 

 

Prognostic Group

28 Day Mortality Rate

good

26%

intermediate

67%

poor

82%

 


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Specialty

Objective

ICD-10