Higher Serum Cortisol is Associated with Delayed Shock Resolution in Septic Shock Patients

Introduction Elevated serum cortisol levels at the onset of septic shock have been linked to increased mortality. However, their relationship with hemodynamic recovery, particularly shock reversal, has not been well studied. Methods We conducted a prospective cohort study at Srinagarind Hospital, Thailand, between June 2019 and December 2021, enrolling adult patients diagnosed with septic shock in the emergency department. Serum cortisol levels and illness severity (SOFA and APACHE III scores) were assessed at diagnosis. Shock reversal was defined as vasopressor discontinuation with sustained mean arterial pressure ≥ 65 mm Hg for 24 h. Results Of 81 enrolled patients, 58 (71.6%) achieved shock reversal within 72 h. Higher serum cortisol levels were independently associated with a lower probability of shock reversal at 72 h (HR per 1 µg/dL increase: 0.95, 95% CI: 0.92-0.97) and with reduced likelihood of early shock control at 6 h (HR: 0.96, 95% CI: 0.93-0.99). Compared with cortisol < 18 µg/dL, levels of 18–30 µg/dL and > 30 µg/dL were associated with substantially lower probabilities of 72-h shock reversal (HR: 0.31, 95% CI: 0.15-0.64; HR: 0.17, 95% CI: 0.08-0.37, respectively). Each 10 µg/dL increase in cortisol corresponded to a 0.64-point increase in SOFA score at 72 h (95% CI: 0.28-1.0). No significant association was observed with 28-day mortality. Conclusion Elevated serum cortisol at the onset of septic shock independently predicted delayed shock reversal and a lower likelihood of early shock control, but was not associated with 28-day mortality.