Absolute and relative adrenal insufficiency in children with septic shock

Absolute and relative adrenal insufficiency in children with septic shock

Author Pizarro, C. F. Google Scholar
Troster, E. J. Google Scholar
Damiani, D. Google Scholar
Carcillo, J. A. Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Objective: Corticosteroid replacement improves outcome in adults with relative adrenal insufficiency and catecholamine-resistant septic shock. We evaluated the relationship of absolute and relative adrenal insufficiency to catecholamine-resistant septic shock in children.Design. Prospective cohort study.Setting. University hospital pediatric intensive care unit in Brazil.Patients. Fifty-seven children with septic shock. Children with HIV infection, those with a history of adrenal insufficiency, and those submitted to any steroid therapy or etomidate within the week before diagnosis of septic shock were excluded.Interventions: None.Measurements and Main Results., A short corticotropin test (250 mu g) was performed, and cortisol levels were measured at baseline and 30 and 60 mins posttest. Adrenal insufficiency was defined by a response <= 9 mu g/dL. Absolute adrenal insufficiency was further defined by a baseline cortisol < 20 mu g/dL and relative adrenal insufficiency by a baseline cortisol > 20 mu g/dL. Absolute adrenal insufficiency was observed in 18% of children, all of whom had catecholamine-resistant shock. Relative adrenal insufficiency was observed in 26% of children, of whom 80% had catecholamine-resistant and 20% had dopamine/dobutamine-responsive shock. All children with fluid-responsive shock had a cortisol response > 9 mu g/dL. Children with adrenal insufficiency had an increased risk of catecholamine-resistant shock (relative risk, 1.88; 95% confidence interval, 1.26-2.79). However, mortality was independently predicted by chronic illness or multiple organ failure (p <.05), not adrenal insufficiency.Conclusions: Absolute and relative adrenal insufficiency is common in children with catecholamine-resistant shock and absent in children with fluid-responsive shock. Studies are warranted to determine whether corticosterold therapy has a survival benefit in children with relative adrenal insufficiency and catecholamine-resistant septic shock.
Keywords septic shock
sepsis
adrenal insufficiency
shock
corticosteroids
cortisol
Language English
Date 2005-04-01
Published in Critical Care Medicine. Philadelphia: Lippincott Williams & Wilkins, v. 33, n. 4, p. 855-859, 2005.
ISSN 0090-3493 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 855-859
Origin http://dx.doi.org/10.1097/01.CCM.0000159854.23324.84
Access rights Closed access
Type Article
Web of Science ID WOS:000228282700024
URI http://repositorio.unifesp.br/handle/11600/28236

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