Intensive Care Medicine

, Volume 33, Issue 10, pp 1761–1766

Adrenal response in patients with septic shock of abdominal origin: relationship to survival

  • Florence C. Riché
  • Carole M. Boutron
  • Patrice Valleur
  • Christine Berton
  • Marie-Josèphe Laisné
  • Jean-Marie Launay
  • Philippe Chappuis
  • Jacqueline Peynet
  • Eric Vicaut
  • Didier Payen
  • Bernard P. Cholley
Original

DOI: 10.1007/s00134-007-0770-4

Cite this article as:
Riché, F.C., Boutron, C.M., Valleur, P. et al. Intensive Care Med (2007) 33: 1761. doi:10.1007/s00134-007-0770-4

Abstract

Objective

To evaluate the prognostic value of adrenocortical response to corticotropin in septic shock patients operated on exclusively for an intra-abdominal source of infection.

Design and setting

Prospective, observational, single-center study in a surgical intensive care unit of a university hospital

Patients

118 consecutive septic shock patients undergoing laparotomy or drainage for intra-abdominal infection.

Measurements and results

Baseline cortisol (t0) and cortisol response to corticotropin test (Δ) were measured during the first 24 h following onset of shock. The relationship between adrenal function test results and survival was analyzed as well as the effect of etomidate anesthesia. Cortisol plasma level at t0 was higher in nonsurvivors than in survivors (33 ± 23 vs. 25 ± 14 μg/dl), but the response to corticotropin test did not differ between these two subgroups. ROC analysis showed threshold values for t0 (32 μg/dl) and Δ (8 μg/dl) that best discriminated survivorsfrom nonsurvivors in our population. We observed no difference in survival at the end of hospital stay using log rank test when patients were separated according to t0, Δ, or both. In addition, adrenal function testsand survival did not differ in patients who received etomidate anesthesia (n = 69) during the surgical treatment of their abdominal sepsis.

Conclusions

In this cohort of patients with abdominal septic shock baseline cortisol level and the response to corticotropin test did not discriminate survivors from nonsurvivors. No deleterious impact of etomidate anesthesia on adrenal function tests and survival was observed in these patients.

Keywords

Cortisol Corticotropin test Abdominal sepsis Etomidate Outcome 

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Florence C. Riché
    • 1
  • Carole M. Boutron
    • 2
  • Patrice Valleur
    • 3
  • Christine Berton
    • 1
  • Marie-Josèphe Laisné
    • 1
  • Jean-Marie Launay
    • 4
  • Philippe Chappuis
    • 4
  • Jacqueline Peynet
    • 4
  • Eric Vicaut
    • 2
  • Didier Payen
    • 1
  • Bernard P. Cholley
    • 1
  1. 1.Department of Anesthesiology and Intensive CareHôpital Lariboisière, AP-HP, Université Paris VIIParisFrance
  2. 2.Department of Digestive SurgeryHôpital Lariboisière, AP-HP, Université Paris VIIParisFrance
  3. 3.Clinical Research UnitHôpital Lariboisière, AP-HP, Université Paris VIIParisFrance
  4. 4.Department of BiochemistryHôpital Lariboisière, AP-HP, Université Paris VIIParisFrance