Abstract Objective To study the changes in serum levels of cortisol and adrenocorticotropic hormone (ACTH) in children with septic shock (SS) and to explore their relationship with the disease severity and prognosis. Methods Twenty-five children with decompensated SS and 24 children with early SS were enrolled. Serum cortisol and ACTH levels were determined on admission and days 3 and 8 after admission. Twenty-five healthy children were used as the control group. The children with decompensated SS were further divided into death group (n=5) and survival group (n=20) based on their clinical outcome. Results On admission, the decompensated SS and early SS groups had significantly higher serum cortisol and ACTH levels than the control group (P P P P P Conclusions Children with SS have increased serum cortisol and ACTH levels, which are associated with the disease severity. A persistent high serum cortisol level indicates a poor prognosis. Dynamic monitoring of serum cortisol and ACTH levels in children with SS is of great significance in evaluating the disease severity and prognosis.
LIN Hai,WANG Zi-Jing,WANG Shi-Biao et al. Changes in serum cortisol and adrenocorticotropic hormone in children with sepsis shock and their clinical significance[J]. CJCP, 2016, 18(10): 1009-1012.
LIN Hai,WANG Zi-Jing,WANG Shi-Biao et al. Changes in serum cortisol and adrenocorticotropic hormone in children with sepsis shock and their clinical significance[J]. CJCP, 2016, 18(10): 1009-1012.
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock[J]. N Engl J Med, 2001, 345(19): 1368-1377.
[8]
Marik PE, Zaloga GP. Adrenal insufficiency in the critically ill: a new look at an old problem[J]. Chest, 2002, 122(5): 1784-1796.
[9]
Hamrahian AH, Oseni TS, Arafah BM. Measurements of serum free cortisol in critically ill patients[J]. N Engl J Med, 2004, 350(16): l629-l638.
[10]
Boonen E, Vervenne H, Meersseman P, et al. Reduced cortisol metabolism during critical illness[J]. N Engl J Med, 2013, 368(16): 1477-1488.
[11]
Annane D, Sébille V, Troché G, et al. A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin[J]. JAMA, 2000, 283(8): 1038-1045.
[12]
Sam S, Corbridge TC, Mokhlesi B, et al. Cortisol levels and mortality in severe sepsis[J]. Clin Endocrinol (Oxf), 2004, 60(1): 29-35.
[13]
Sharshar T, Gray F, Lorin de la Grandmaison G, et a1. Apoptosis of neurons in cardiovascular autonomic centres triggered by inducible nitric oxide synthase after death from septic shock[J]. Lancet, 2003, 362(9398): 1799-1805.