Clinical Studies In Septic Children With Cortisol, Adrenocorticotropic Hormone Levels And Related Indicators

Objective:To observe the levels of serum cortisol(COR)、 adrenocorticotrophic hormone(ACTH) in the sepsis children, exploring the clinical significance and the value in the judgment of the prognosis.Method:40 sepsis children in ICU of Children’s Hospital of Chongqing Medical University from February 2013 to August 2013 were selected,21 children in sepsis group and 19 children in severe sepsis group, and 20 healthy children was selected as control group, monitoring the levels of COR and ACTH in the sepsis and healthy children. According to the area under the receiver operating curve (AUC), to analysis the value of COR and ACTH in the judgment of the prognosis of sepsis patients.Results:(1) In severe sepsis group, the levels of COR and ACTH were higher than sepsis group and control group, and those in sepsis group were higher than control group, the differences were statistically significant.(2) The differences of data like COR, ACTH, PCIS, LAC, PCT, CRP, INR, PLT, BUN between sepsis group and severe sepsis group were statistically significant(P<0.05), but there was no significant in Cr、APTT、WBC and GLU(P>0.05).(3) According to the prognosis, the differences of COR, ACTH, PCIS, LAC between death group and survival group were significant(P<0.05),and no significant in INR、PLT、BUN、CR、APTT、 CRP、PCT、WBC、GLU(P>0.05).(4) Correlation analysis:COR was positively correlated with ACTH and Lac(r=0.445,0.406, P<0.05); and negtively correlated with PCIS(r=-0.339, P<0.005); but no correlation with CRP、PCT and WBC(P>0.05). ACTH was positively correlated with COR, LAC, CRP(r=0.445vs 0.560vs 0.324, P<0.05); negatively correlated with PCIS(r=-0.332, P<0.005), but no correlation with PCT and WBC(P>0.05). (5) Evaluation of ROC:the AUC of COR was 0.792(P<0.05), and the AUC of ACTH was 0.881(P<0.05).Conclusion:In the sepsis children, the levels of serum COR and ACTH increased significantly. They could be used as serious index and evaluating the prognosis of children with sepsis. This study had not found the levels of serum COR decreasing in children with severe sepsis.Therefore, glucocorticoid therapy should be careful.