Effects of serum cortisol level and steroid therapy on mortality in septic shock patients

Septic shock is a major cause of mortality in intensive care units. The trials on diagnosis and treatment of this condition still continue.Severe illness and stres strongly activate the hypothalamic- pituitary- adrenal axis and stimulate the release of ACTH from the pituitary, which in turn increases the release of cortisol from the adrenal cortex. Many critically ill patients develop reversible failure of the HPA axis. This activation is an essential component of the general adaptation to illness and stres and contributes to the maintenance of cellular and organ homeostasis. Therefore, many studies and The ACCP/SCCM Consensus Conference Committee advocated steroid therapy in septic shock patients who remained hypotensive after the resuscitation with fluid and vasopressors.In this study we want to assess, is there a survival benefit in the patients with low plasma cortisol levels who was given steroid therapy. The study performed in the Gazi University Faculty of Medicine the Intensive Care Unit of Internal Medicine, patients who diagnosed as septic shock and also plasma cortisol levels were measured, analyzed retrospectively. 91 patients whose plasma cortisol levels were seen enrolled in the study. 22 of those plasma cortisol level was <15?gr / dl. And 69 patients the plasma cortisol level was > 15?gr / dl. The two groups was not statistical difference in terms of demographic data. Independent of steroid therapy death rate in the group that plasma cortisol level > 15?gr / dl was statistically significantly higher. There was no significant effect on mortality of the steroid therapy. We determined that increased mortality in patients with increased plasma cortisol levels.Key words: Hipothalamo- pituitary- adrenal axis, adrenal insufficiency, steroid therapy.