February 23, 2000JAMA
A 3-Level Prognostic Classification in Septic Shock Based on Cortisol Levels and Cortisol Response to Corticotropin
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Discussion
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Implication
Prospective cohort study reveals a three-level mortality risk profile based on cortisol response in septic shock, highlighting adrenal responsiveness as a key prognostic marker.
Key Points
- To determine the prognostic value of baseline cortisol levels and cortisol response during a short corticotropin stimulation test in patients with septic shock.
- Prospective inception cohort study of 189 consecutive adult patients meeting clinical criteria for septic shock across two intensive care units in France.
- Conducted a short corticotropin stimulation test via intravenous administration of 0.25 mg tetracosactrin, recording cortisol concentrations at baseline (T0), 30 minutes (T30), and 60 minutes (T60) to evaluate 28-day mortality.
- Overall 28-day mortality reached 58% (95% CI, 51%–65%), with baseline cortisol >34 µg/dL and a peak cortisol increase (delta max) ≤9 µg/dL identified as independent predictors of mortality (P ≤ 0.001).
- Classification by adrenal profile stratified patients into good (baseline cortisol ≤34 µg/dL and delta max >9 µg/dL; 28-day mortality 26%), intermediate (28-day mortality 67%), and poor prognosis groups (baseline cortisol >34 µg/dL and delta max ≤9 µg/dL; 28-day mortality 82%).
Cite This Study
Djillali Annane (2000) studied this question.