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Original Article - Basic Research08-01-2012
Interleukin-12 in children with sepsis and septic shock
Revista Brasileira de Terapia Intensiva. 2012;24(2):130-136
Abstract
Original Article - Basic ResearchInterleukin-12 in children with sepsis and septic shock
Revista Brasileira de Terapia Intensiva. 2012;24(2):130-136
DOI 10.1590/S0103-507X2012000200006
Views47See moreOBJECTIVE: To examine the behavior of interleukin-12 and verify whether it can be used to differentiate septic conditions in children. METHODS: Septic children aged between 28 days and 14 years, prospectively enrolled from 01/2004 to 12/2005, were divided into sepsis (SG; n=47) and septic shock (SSG; n=43) groups. Interleukin-12 levels were measured at admission (T0) and 12 hours later (T12). Disease severity was assessed by the PRISM score. RESULTS: Interleukin-12 levels did not differentiate children with sepsis from those with septic shock at admission [SSG: 0.24 (0-226.4)=SG: 1.23 (0-511.6); p=0.135)] and T12 [SG: 6.11 (0-230.5)=SSG: 1.32 (0-61.0); p=0.1239)]. Comparing time points, no significant difference was observed in the SG [SG, T0: 1.23 (0-511.6)=T12: 6.11 (0-230.5); p=0.075]. In SSG however, interleukin-12 increased from T0 to T12 (SSG, T0: 0.24 (0-226.4)
Views47
Abstract
Original Article - Basic ResearchInterleukin-12 in children with sepsis and septic shock
Revista Brasileira de Terapia Intensiva. 2012;24(2):130-136
DOI 10.1590/S0103-507X2012000200006
Views47See moreOBJECTIVE: To examine the behavior of interleukin-12 and verify whether it can be used to differentiate septic conditions in children. METHODS: Septic children aged between 28 days and 14 years, prospectively enrolled from 01/2004 to 12/2005, were divided into sepsis (SG; n=47) and septic shock (SSG; n=43) groups. Interleukin-12 levels were measured at admission (T0) and 12 hours later (T12). Disease severity was assessed by the PRISM score. RESULTS: Interleukin-12 levels did not differentiate children with sepsis from those with septic shock at admission [SSG: 0.24 (0-226.4)=SG: 1.23 (0-511.6); p=0.135)] and T12 [SG: 6.11 (0-230.5)=SSG: 1.32 (0-61.0); p=0.1239)]. Comparing time points, no significant difference was observed in the SG [SG, T0: 1.23 (0-511.6)=T12: 6.11 (0-230.5); p=0.075]. In SSG however, interleukin-12 increased from T0 to T12 (SSG, T0: 0.24 (0-226.4)
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Original Article05-04-2009
Related prognostic factors in elderly patients with severe sepsis and septic shock
Revista Brasileira de Terapia Intensiva. 2009;21(1):9-17
Abstract
Original ArticleRelated prognostic factors in elderly patients with severe sepsis and septic shock
Revista Brasileira de Terapia Intensiva. 2009;21(1):9-17
DOI 10.1590/S0103-507X2009000100002
Views81See moreOBJECTIVES: The objective of this study was to evaluate variables related to intra hospital mortality at 28 days, of aged persons with severe sepsis and septic shock in a clinical ICU. METHODS: One hundred and fifty-two patients aged > 65 years with severe sepsis and septic shock were followed for 28 days and the variables were collected on days 1, 3, 5, 7, 14 and 28 of stay. To compare categorical variables the Chi-square test was used and the Mann-Whitney or t test for continuous variables. All tests were double-tailed, alpha error of 0.05. RESULTS: Mean age was 82.0 ± 9.0 years and 64.5% were female. Mortality was of 47.4%. Related to death were the following: Acute Physiological and Chronic Heath Evaluation II score (p < 0.001), Sequential Organ Failure Assessment score on days 1, 3, 5, 7 (p < 0.001), length of stay in intensive care (p < 0.001), number of organ failures (p < 0.001), high serum lactate on day 3 (p = 0.05), positive troponin I (p < 0.01), echocardiographic variables (systolic diameter p = 0.005; diastolic diameter p = 0.05; shortening fraction p = 0.02), previous renal disease (p = 0.03), shock (p < 0.001), mechanical ventilation (p < 0.001) and Lawton scale (p = 0.04). CONCLUSIONS: Shock, elevated lactate, organ failure, especially respiratory were more prevalent in non-survivors. Heart dysfunction detected by echocardiographic variables and positive troponin I may play an important role in the mortality of aged patients with sepsis.
Views81Abstract
Original ArticleRelated prognostic factors in elderly patients with severe sepsis and septic shock
Revista Brasileira de Terapia Intensiva. 2009;21(1):9-17
DOI 10.1590/S0103-507X2009000100002
Views81See moreOBJECTIVES: The objective of this study was to evaluate variables related to intra hospital mortality at 28 days, of aged persons with severe sepsis and septic shock in a clinical ICU. METHODS: One hundred and fifty-two patients aged > 65 years with severe sepsis and septic shock were followed for 28 days and the variables were collected on days 1, 3, 5, 7, 14 and 28 of stay. To compare categorical variables the Chi-square test was used and the Mann-Whitney or t test for continuous variables. All tests were double-tailed, alpha error of 0.05. RESULTS: Mean age was 82.0 ± 9.0 years and 64.5% were female. Mortality was of 47.4%. Related to death were the following: Acute Physiological and Chronic Heath Evaluation II score (p < 0.001), Sequential Organ Failure Assessment score on days 1, 3, 5, 7 (p < 0.001), length of stay in intensive care (p < 0.001), number of organ failures (p < 0.001), high serum lactate on day 3 (p = 0.05), positive troponin I (p < 0.01), echocardiographic variables (systolic diameter p = 0.005; diastolic diameter p = 0.05; shortening fraction p = 0.02), previous renal disease (p = 0.03), shock (p < 0.001), mechanical ventilation (p < 0.001) and Lawton scale (p = 0.04). CONCLUSIONS: Shock, elevated lactate, organ failure, especially respiratory were more prevalent in non-survivors. Heart dysfunction detected by echocardiographic variables and positive troponin I may play an important role in the mortality of aged patients with sepsis.
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Review Article07-16-2008
Drotrecogin alfa activated in clinical practice and the current evidences
Revista Brasileira de Terapia Intensiva. 2008;20(2):173-177
Abstract
Review ArticleDrotrecogin alfa activated in clinical practice and the current evidences
Revista Brasileira de Terapia Intensiva. 2008;20(2):173-177
DOI 10.1590/S0103-507X2008000200010
Views51See moreBACKGROUND AND OBJECTIVES: The debate on efficacy and patient safety related to the use of drotrecogin alfa (DrotAA) is timely, principally due to the negative results observed in clinical studies performed after the PROWESS study, and the economic cost-related impact of the drug on the healthcare system. The aim of this study was to review the main studies on the use of DrotAA in patients with severe sepsis. The focus was on drug efficacy-and patient safety-related issues. CONTENTS: Articles were selected by a MedLine search for studies on the use of DrotAA in patients with sepsis using the following key words: activated protein C; drotrecogin alfa; sepsis; septic shock; Xigris®. Additional references were retrieved from the studies initially selected. CONCLUSIONS: Mortality and bleeding complications associated with the use of DrotAA were more frequent in large observational studies than those reported in randomized trials. In the light of the current knowledge, routine use of DrotAA should be reevaluated until well-designed confirmatory clinical trials can clarify the true efficacy and safety of the drug and help identify the subgroup of patients that can benefit from use of DrotAA. Physicians should be cautious with the rapid transfer of evidences not well-documented, to the guidelines and recommendations practiced in the care and treatment of patients with severe sepsis.
Views51Abstract
Review ArticleDrotrecogin alfa activated in clinical practice and the current evidences
Revista Brasileira de Terapia Intensiva. 2008;20(2):173-177
DOI 10.1590/S0103-507X2008000200010
Views51See moreBACKGROUND AND OBJECTIVES: The debate on efficacy and patient safety related to the use of drotrecogin alfa (DrotAA) is timely, principally due to the negative results observed in clinical studies performed after the PROWESS study, and the economic cost-related impact of the drug on the healthcare system. The aim of this study was to review the main studies on the use of DrotAA in patients with severe sepsis. The focus was on drug efficacy-and patient safety-related issues. CONTENTS: Articles were selected by a MedLine search for studies on the use of DrotAA in patients with sepsis using the following key words: activated protein C; drotrecogin alfa; sepsis; septic shock; Xigris®. Additional references were retrieved from the studies initially selected. CONCLUSIONS: Mortality and bleeding complications associated with the use of DrotAA were more frequent in large observational studies than those reported in randomized trials. In the light of the current knowledge, routine use of DrotAA should be reevaluated until well-designed confirmatory clinical trials can clarify the true efficacy and safety of the drug and help identify the subgroup of patients that can benefit from use of DrotAA. Physicians should be cautious with the rapid transfer of evidences not well-documented, to the guidelines and recommendations practiced in the care and treatment of patients with severe sepsis.
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Original Article07-15-2008
Characteristics and outcomes of patients treated with drotrecogin alpha and other interventions of the “Surviving Sepsis” campaign in clinical practice
Revista Brasileira de Terapia Intensiva. 2008;20(2):135-143
Abstract
Original ArticleCharacteristics and outcomes of patients treated with drotrecogin alpha and other interventions of the “Surviving Sepsis” campaign in clinical practice
Revista Brasileira de Terapia Intensiva. 2008;20(2):135-143
DOI 10.1590/S0103-507X2008000200004
Views42See moreBACKGROUND AND OBJECTIVES: To face the high mortality of sepsis, interventions grouped as "Surviving Sepsis Campaign" have been suggested. The aim of the study was to describe the application of glycemic control, corticoid use in septic shock, inotropics and drotrecogin-alpha in sepsis. METHODS: We studied 110 patients with sepsis from Recife/Brazil, who received drotrecogin-alpha between 2003/2006. Data on management of sepsis considering Surviving Sepsis Campaign, drotrecogin-alpha, mortality at 28 days and severe bleeding were recorded. RESULTS: Mean APACHE II was 25.6 and mean SOFA was 9.2. Around 95% of the patients presented two or more organ dysfunctions and 98% presented septic shock. The majority (56%) were under 65 years. Abdominal (48%) and respiratory (28%) focus of infection were the most prevalent. Hydrocortisone was used in 61% of the patients, and 29 (48.3%) died. Of the 38 patients with prolonged shock that did not receive it, 28 (73.7%) died. Of the 97 patients who presented uncontrolled glycemia only 65% achieved strict glycemic control and the mortality was 51.6%. Fluid gain ranged from 600 ml to 9,400 ml in the first 24h. In only 30 patients was myocardial dysfunction detected. The infusion of drotrecogin alpha started within 24h in 45%, between 24 and 48h in 35% and after 48h in 20%. Death occurred in 57% and severe bleeding in 9%. CONCLUSIONS: Discrepancy between the recommendations of Surviving Sepsis Campaign and clinical practice was observed. Death rate was 57%, similar to that found in the literature for septic shock irrespective of the use of drotrecogin-alpha.
Views42Abstract
Original ArticleCharacteristics and outcomes of patients treated with drotrecogin alpha and other interventions of the “Surviving Sepsis” campaign in clinical practice
Revista Brasileira de Terapia Intensiva. 2008;20(2):135-143
DOI 10.1590/S0103-507X2008000200004
Views42See moreBACKGROUND AND OBJECTIVES: To face the high mortality of sepsis, interventions grouped as "Surviving Sepsis Campaign" have been suggested. The aim of the study was to describe the application of glycemic control, corticoid use in septic shock, inotropics and drotrecogin-alpha in sepsis. METHODS: We studied 110 patients with sepsis from Recife/Brazil, who received drotrecogin-alpha between 2003/2006. Data on management of sepsis considering Surviving Sepsis Campaign, drotrecogin-alpha, mortality at 28 days and severe bleeding were recorded. RESULTS: Mean APACHE II was 25.6 and mean SOFA was 9.2. Around 95% of the patients presented two or more organ dysfunctions and 98% presented septic shock. The majority (56%) were under 65 years. Abdominal (48%) and respiratory (28%) focus of infection were the most prevalent. Hydrocortisone was used in 61% of the patients, and 29 (48.3%) died. Of the 38 patients with prolonged shock that did not receive it, 28 (73.7%) died. Of the 97 patients who presented uncontrolled glycemia only 65% achieved strict glycemic control and the mortality was 51.6%. Fluid gain ranged from 600 ml to 9,400 ml in the first 24h. In only 30 patients was myocardial dysfunction detected. The infusion of drotrecogin alpha started within 24h in 45%, between 24 and 48h in 35% and after 48h in 20%. Death occurred in 57% and severe bleeding in 9%. CONCLUSIONS: Discrepancy between the recommendations of Surviving Sepsis Campaign and clinical practice was observed. Death rate was 57%, similar to that found in the literature for septic shock irrespective of the use of drotrecogin-alpha.
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Original Article07-15-2008
Sepsis in the intensive care unit: etiologies, prognostic factors and mortality
Revista Brasileira de Terapia Intensiva. 2008;20(2):128-134
Abstract
Original ArticleSepsis in the intensive care unit: etiologies, prognostic factors and mortality
Revista Brasileira de Terapia Intensiva. 2008;20(2):128-134
DOI 10.1590/S0103-507X2008000200003
Views137See moreBACKGROUND AND OBJECTIVES: Sepsis is the main cause of death in patients treated in intensive care units (ICU). The aim of this study was to evaluate etiology, prognostic factors and mortality of septic patients treated in ICU of Passo Fundo, Brazil. METHODS: Out of 971 consecutive patients prospectively evaluated from August 2005 to February 2006, 560 were selected due to presence of systemic inflammatory response syndrome (SIRS) and followed for 28 days or until discharge or death. Patients were categorized according with the etiology of SIRS and further classified as having SIRS, sepsis, severe sepsis and septic shock. Prognosis was assessed by means of Apache II and SOFA. Mortality was compared in different etiologies of sepsis, APACHE II and SOFA scores, parameters. RESULTS: Of the 971 patients admitted to the ICU, 560 developed SIRS (58%). The most frequent cause of internation was neurological disease (28.9%), the most frequent site of infection was the respiratory tract (71.6%), and the most prevalent pathogens were gram-negative bacilli (53.2%). Mean APACHE II score was 18 ± 9, and mean SOFA score was 5 ± 4. Median ICU stay was 6 (3-11) days and overall mortality rate was 31.1%: 6.1% for non-infectious SIRS, 10.1% for sepsis, 22.6% for severe sepsis, and 64.8% for septic shock. CONCLUSIONS: Sepsis is an important health problem that leads to an extremely high mortality rate in the ICU of Passo Fundo, Brazil.
Views137Abstract
Original ArticleSepsis in the intensive care unit: etiologies, prognostic factors and mortality
Revista Brasileira de Terapia Intensiva. 2008;20(2):128-134
DOI 10.1590/S0103-507X2008000200003
Views137See moreBACKGROUND AND OBJECTIVES: Sepsis is the main cause of death in patients treated in intensive care units (ICU). The aim of this study was to evaluate etiology, prognostic factors and mortality of septic patients treated in ICU of Passo Fundo, Brazil. METHODS: Out of 971 consecutive patients prospectively evaluated from August 2005 to February 2006, 560 were selected due to presence of systemic inflammatory response syndrome (SIRS) and followed for 28 days or until discharge or death. Patients were categorized according with the etiology of SIRS and further classified as having SIRS, sepsis, severe sepsis and septic shock. Prognosis was assessed by means of Apache II and SOFA. Mortality was compared in different etiologies of sepsis, APACHE II and SOFA scores, parameters. RESULTS: Of the 971 patients admitted to the ICU, 560 developed SIRS (58%). The most frequent cause of internation was neurological disease (28.9%), the most frequent site of infection was the respiratory tract (71.6%), and the most prevalent pathogens were gram-negative bacilli (53.2%). Mean APACHE II score was 18 ± 9, and mean SOFA score was 5 ± 4. Median ICU stay was 6 (3-11) days and overall mortality rate was 31.1%: 6.1% for non-infectious SIRS, 10.1% for sepsis, 22.6% for severe sepsis, and 64.8% for septic shock. CONCLUSIONS: Sepsis is an important health problem that leads to an extremely high mortality rate in the ICU of Passo Fundo, Brazil.
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Artigo Original Destaque05-06-2006
An epidemiological study of sepsis in Intensive Care Units: Sepsis Brazil study
Revista Brasileira de Terapia Intensiva. 2006;18(1):9-17
Abstract
Artigo Original DestaqueAn epidemiological study of sepsis in Intensive Care Units: Sepsis Brazil study
Revista Brasileira de Terapia Intensiva. 2006;18(1):9-17
DOI 10.1590/S0103-507X2006000100003
Views28See moreBACKGROUND AND OBJECTIVES: Sepsis represents the major cause of death in the ICUs all over the world. Many studies have shown an increasing incidence over time and only a slight reduce in mortality. Many new treatment strategies are arising and we should define the incidence and features of sepsis in Brazil. METHODS: Prospective cohort study in sixty-five hospitals all over Brazil. The patients who were admitted or who developed sepsis during the month of September, 2003 were enrolled. They were followed until the 28th day and/or until their discharge. The diagnoses were made in accordance to the criteria proposed by ACCP/SCCM. It were evaluated demographic features, APACHE II score, SOFA (Sepsis-related Organ Failure Assessment) score, mortality, sources of infections, microbiology, morbidities and length of stay (LOS). RESULTS: Seventy-five ICUs from all regions of Brazil took part in the study.3128 patients were identified and 521 (16.7%) filled the criteria of sepsis, severe sepsis or septic shock. Mean age was 61.7 (IQR 39-79), 293 (55.7%) were males, and the overall 28-day mortality rate was 46.6%. Average APACHE II score was 20 and SOFA score on the first day was 7 (IQR 4-10). SOFA score in the mortality group was higher on day 1 (8, IQR 5-11), and had increased on day 3 (9, IQR 6-12). The mortality rate for sepsis, severe sepsis and septic shock was 16.7%, 34.4% and 65.3%, respectively. The average LOS was 15 days (IQR 5-22). The two main sources of infection were the respiratory tract (69%) and the abdomen one (23.1%). Gram-negative bacilli were more prevalent (40.1%). Gram-positive cocci were identified in 32.8% and fungi infections in 5%. Mechanical ventilation was observed in 82.1% of the patients, Swan-Ganz catheter in 18.8%, vasopressors in 66.2% and hemotransfusion in 44.7%. CONCLUSIONS: It was observed a high mortality of sepsis in the ICUs in Brazil. The high frequency of septic shock demonstrated a group at high risk of death. In order to have a better use of the resources and reduce in mortality during the next 5 years, it is very important to identify our specific features related to this syndrome.
Views28Abstract
Artigo Original DestaqueAn epidemiological study of sepsis in Intensive Care Units: Sepsis Brazil study
Revista Brasileira de Terapia Intensiva. 2006;18(1):9-17
DOI 10.1590/S0103-507X2006000100003
Views28See moreBACKGROUND AND OBJECTIVES: Sepsis represents the major cause of death in the ICUs all over the world. Many studies have shown an increasing incidence over time and only a slight reduce in mortality. Many new treatment strategies are arising and we should define the incidence and features of sepsis in Brazil. METHODS: Prospective cohort study in sixty-five hospitals all over Brazil. The patients who were admitted or who developed sepsis during the month of September, 2003 were enrolled. They were followed until the 28th day and/or until their discharge. The diagnoses were made in accordance to the criteria proposed by ACCP/SCCM. It were evaluated demographic features, APACHE II score, SOFA (Sepsis-related Organ Failure Assessment) score, mortality, sources of infections, microbiology, morbidities and length of stay (LOS). RESULTS: Seventy-five ICUs from all regions of Brazil took part in the study.3128 patients were identified and 521 (16.7%) filled the criteria of sepsis, severe sepsis or septic shock. Mean age was 61.7 (IQR 39-79), 293 (55.7%) were males, and the overall 28-day mortality rate was 46.6%. Average APACHE II score was 20 and SOFA score on the first day was 7 (IQR 4-10). SOFA score in the mortality group was higher on day 1 (8, IQR 5-11), and had increased on day 3 (9, IQR 6-12). The mortality rate for sepsis, severe sepsis and septic shock was 16.7%, 34.4% and 65.3%, respectively. The average LOS was 15 days (IQR 5-22). The two main sources of infection were the respiratory tract (69%) and the abdomen one (23.1%). Gram-negative bacilli were more prevalent (40.1%). Gram-positive cocci were identified in 32.8% and fungi infections in 5%. Mechanical ventilation was observed in 82.1% of the patients, Swan-Ganz catheter in 18.8%, vasopressors in 66.2% and hemotransfusion in 44.7%. CONCLUSIONS: It was observed a high mortality of sepsis in the ICUs in Brazil. The high frequency of septic shock demonstrated a group at high risk of death. In order to have a better use of the resources and reduce in mortality during the next 5 years, it is very important to identify our specific features related to this syndrome.
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Review Article04-28-2006
Terlipressin as a new therapeutic agent in septic shock
Revista Brasileira de Terapia Intensiva. 2006;18(2):196-199
Abstract
Review ArticleTerlipressin as a new therapeutic agent in septic shock
Revista Brasileira de Terapia Intensiva. 2006;18(2):196-199
DOI 10.1590/S0103-507X2006000200014
Views56See moreBACKGROUND AND OBJECTIVES: The hemodynamic support of sepsis is now formulated trying to insert terlipressin as salvage drug in catecholamine resistant shock, justifying a broad critical analysis. CONTENTS: The analysis included hemodynamic therapies with defined specific goals and new recommendations for fluid resuscitation, vasopressor therapy, and inotropic therapy of septic in adult and pediatric patients. CONCLUSIONS: Terlipressin appears as a new but controversial alternative for vasopressor therapy in sepsis.
Views56Abstract
Review ArticleTerlipressin as a new therapeutic agent in septic shock
Revista Brasileira de Terapia Intensiva. 2006;18(2):196-199
DOI 10.1590/S0103-507X2006000200014
Views56See moreBACKGROUND AND OBJECTIVES: The hemodynamic support of sepsis is now formulated trying to insert terlipressin as salvage drug in catecholamine resistant shock, justifying a broad critical analysis. CONTENTS: The analysis included hemodynamic therapies with defined specific goals and new recommendations for fluid resuscitation, vasopressor therapy, and inotropic therapy of septic in adult and pediatric patients. CONCLUSIONS: Terlipressin appears as a new but controversial alternative for vasopressor therapy in sepsis.
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Original Article04-16-2008
Relative adrenal insufficiency in septic shock: comparison of the response to hydrocortisone in patients diagnosed through random cortisol measurement versus corticotropin test
Revista Brasileira de Terapia Intensiva. 2008;20(1):18-23
Abstract
Original ArticleRelative adrenal insufficiency in septic shock: comparison of the response to hydrocortisone in patients diagnosed through random cortisol measurement versus corticotropin test
Revista Brasileira de Terapia Intensiva. 2008;20(1):18-23
DOI 10.1590/S0103-507X2008000100003
Views55See moreBACKGROUND AND OBJECTIVES: The incidence of relative adrenal insufficiency (RAI) in patients with septic shock is high and has a significant impact on survival. The purpose of this study was to determine whether a random cortisol concentration < 25 mg/dL was as good as a low dose (1 mg) corticotrophin stimulation test in the diagnosis of RAI in patients with septic shock as assessed by the hemodynamic response to hydrocortisone. METHODS: Patients were randomized to a single cortisol determination or to a low dose corticotrophin stimulation test. After blood collection to cortisol determinations, hydrocortisone (100 mg every 8 hrs) was administered for all patients in the first 36 hours. RAI was defined by a random cortisol concentration < 25 mg/dL or a D cortisol concentration < 9 mg/dL in the corticotrophin test. RESULTS: Sixty patients (G1 = 30; G2 = 30) were included in the analysis and were comparable regarding to demographic data, nosologies and disease severity. The time to norepinephrin withdrawal in group 1 patients with RAI diagnostic criteria was not different from the patients with cortisol > 25 mg/dL. In group 2 patients with D cortisol < 9 mg/dL had a shorter time of norepinephrin infusion (3 days) compared to patients with D cortisol > 9 (6 days). CONCLUSIONS: This study suggests that 1 mg corticotrophin test is better than a random cortisol determination < 25 mg/dL to the diagnosis of relative adrenal insufficiency in septic shock patients.
Views55Abstract
Original ArticleRelative adrenal insufficiency in septic shock: comparison of the response to hydrocortisone in patients diagnosed through random cortisol measurement versus corticotropin test
Revista Brasileira de Terapia Intensiva. 2008;20(1):18-23
DOI 10.1590/S0103-507X2008000100003
Views55See moreBACKGROUND AND OBJECTIVES: The incidence of relative adrenal insufficiency (RAI) in patients with septic shock is high and has a significant impact on survival. The purpose of this study was to determine whether a random cortisol concentration < 25 mg/dL was as good as a low dose (1 mg) corticotrophin stimulation test in the diagnosis of RAI in patients with septic shock as assessed by the hemodynamic response to hydrocortisone. METHODS: Patients were randomized to a single cortisol determination or to a low dose corticotrophin stimulation test. After blood collection to cortisol determinations, hydrocortisone (100 mg every 8 hrs) was administered for all patients in the first 36 hours. RAI was defined by a random cortisol concentration < 25 mg/dL or a D cortisol concentration < 9 mg/dL in the corticotrophin test. RESULTS: Sixty patients (G1 = 30; G2 = 30) were included in the analysis and were comparable regarding to demographic data, nosologies and disease severity. The time to norepinephrin withdrawal in group 1 patients with RAI diagnostic criteria was not different from the patients with cortisol > 25 mg/dL. In group 2 patients with D cortisol < 9 mg/dL had a shorter time of norepinephrin infusion (3 days) compared to patients with D cortisol > 9 (6 days). CONCLUSIONS: This study suggests that 1 mg corticotrophin test is better than a random cortisol determination < 25 mg/dL to the diagnosis of relative adrenal insufficiency in septic shock patients.
septic shock Archives - Critical Care Science (CCS)
