Adrenocortical status in infants and children with sepsis and septic shockI

Abstract EN

-The benefit from corticosteroids remains controversial in sepsis and septic shock and the presence of adrenal insufficiency (AI) has been proposed to justify steroid use.

Aim: To determine adrenal state and its relation with outcome in critical children admitted with sepsis to PICU of Cairo University, Children Hospital.

Methods: Thirty cases with sepsis and septic shock were studied.

Cortisol levels (CL) were estimated at baseline and after high-dose short ACTH stimulation in those patients and in 30 matched controls.

Absolute AI was defined as basal CL< 7 lg/dl and peak CL< 18 lg/dl.

Relative AI was diagnosed if cortisol increment after stimulation is <9 lg/dl.

Results: Overall mortality of cases was 50%.

The mean CL at baseline in cases was higher than that of controls (51.39 lg/dl vs.

12.83 lg/dl, p= 0.000).

The mean CL 60 min after ACTH stimulation was higher than that of controls (73.38 lg/dl vs.

32.80 lg/dl, p= 0.000).

The median of %rise in cases was lower than that of controls (45.3% vs.

151.7%).

There was a positive correlation between basal and post-stimulation cortisol with number of system failure, inotropic support duration, mechanical ventilation days, and CO2 level in blood.

There was a negative correlation between basal and post stimulation cortisol with blood pH and HCO3.

Conclusion: RAI is common with severe sepsis/septic shock.

It is associated with more inotropic support and has higher mortality.

Studies are warranted to determine whether corticosteroid therapy has a survival benefit in children with RAI and catecholamine resistant septic shock.