The Dynamic Changes Of Plasma Cortisol In Patients With Sepsis And Its’ Clinical Significance

Objective To observe the dynamic changes of plasma cortisol levels in patients with sepsis and to explore its possible mechanism, and to evaluate its clinical significance in evaluating the severity and prognosis of sepsis; To evaluate the effect of low-dose glucocorticoid therapy on severe sepsis and septic shockMethods115patients were collected in our hospital emergency medicine ward according to the diagnostic standard of patients with sepsis in2012January to2012December. They were divided into sepsis group and severe sepsis and septic shock group according to the severity of disease and were divided into survival group and death group according to prognosis.40patients without sepsis were collected in the same period as control group. The patients with severe sepsis and septic shock were classified hormone treatment group (35cases) and control group (30cases) randomly. We give Hydrocortisone sodium succinate200mg/d to hormone treatment group for seven consecutive days; The other group do not use hormone. They were also divided into survival group and death group according to28day mortality. Two group patients are monitored body temperature(T), heart rate(HR), mean arterial pressure(MAF), C-reaction protein(CRP), Procalcitonin(PCT), arterial blood lactate (LAC), arterial partial pressure of oxygen(PaO2), blood PH (PH), white blood cell (WBC), platelet (PLT), cortisol(COR), adreno-cortico-tropic-hormone (ACTH) and APACHE11score, collect venous blood serum COR and ACTH at six o’clock respectively on1st day,3rd day and7th day, and analysis the dynamic changes of the COR and ACTH of different severity and prognosis of patients with sepsis. Using Spearman’s correlation analysis and multivariate Logistic regression analysis, mapping receiver operating characteristic (ROC) curve and calculate the area under the curve analysis affect the prognosis of patients with sepsis risk factors and plasma cortisol in patients with sepsis prognosis value. Analyze and compare the COR, ACTH, PCT and CRP, APACHE Ⅱ and SOFA score for severe sepsis and sepsis shock group before and after glucocorticoid treatment, and to analyze the correlation of COR, ACTH with APACHE Ⅱ score. Results (1) The COR, ACTH level in sepsis group is higher than the control group obviously on1st,3rd and7th day after the diagnosis of sepsis, statistically significant(P<0.05), and cortisol continue to rise.(2) With the development of the disease, the COR and ACTH level are higher in severe sepsis and septic shock patients compare to patients with sepsis from diagnosis of sepsis1st,3rd and7th day, there was statistically significant (P<0.05), and cortisol continue to rise, too.(3) The COR levels of death group is higher than the survival group on seventh day, and there was statistically significant(P<0.05).(4) Plasma cortisol and ACTH,, PCT, CRP, APACHE Ⅱ were positively correlated according to Spearman’s correlation analysis (5) Logistic regression analysis showed that cortisol is an independent risk factor for the prognosis of patients with sepsis.(6) There had no statistical significance between the hormone treatment group and the hormone treatment group before glucocorticoid treatment(P>0.05).(7) The measured COR, PCT and CRP levels after treatment3and7days in hormone treatment group are lower than before treatment, statistically significant (P<0.05), COR decrease more significant(P<0.01); The COR and PCT levels on7th day decreased significantly in hormone treatment compare to the other group, with statistical difference (P<0.05).(8) There are statistically significant in shock reversal time and28days mortality between hormone treatment group and not hormone treatment group, but no statistical difference was found in double fatality rate of infection.Conclusion (1) The cortisol and ACTH levels was significantly elevated in early stage of sepsis patients. The sustained and high expression of cortisol level prompts a serious condition and it is an independent risk factor for judging the prognosis of patients with sepsis.(2) the plasma COR, PCT and CRP level are higher in patients with sepsis, and there are positively correlation between them and APACHE Ⅱ score, and they can reflect the severity of sepsis in a certain extent.(3) Glucocorticoid treatment can inhibit the inflammatory response and reduce the shock reversal time and mortality in patients with septic shock.