Clinical Study Of Variation Of The Serum Cortisol Levels In Children With Sepsis

The prosperpective observational study aimed at assessing the predictive values of serum Cortisol level in determining sepsis progression and mortality of children.Mthod: A Total of 79 children with sepsis who were older than 2 months,excluding chronic adrenal diseases or special disease, and admitted to the PICU of Hu Nan Children' Hospital from September 1,2014 to April 1,2015 were enrolled. Serum Cortisol were measured within 24 h of PICU admissiom,respectively at 8:00,16:00 and 0:00. They wew divided into mild sepsis group(54 cases) and sever sepsis group(25 cases) on the basis of sepsis guidelines of 2012. Ac Cording to the prognosis, they were divided into survivors(64 cases) and nonsurviors(15 cases). Ac Cording to the Cortisol value divided them into three groups: Cor?22.4?g/dl group(32 cases),22.4?g/dl<Cor<45?g/dl group(31 cases),Cor?45?g/dl group(31 cases).Coinstantaneously,15 patients without sepsis or critical illness were included as the control group.To monitor the changes of the Cortisol circadian rhythm in children with sepsis.Analysis of the Cortisol changes at different condition?different degrees of organ failure and prognosis for the patient.Results:1.At the same time, the level of serum Cortisol in sepsis was obviously higher than those in control group ? 24.65( 16.31-38.52) ?g/dl vs 14.42(7.23-20.00)?g/dl, P<0.05?. The level of serum Cortisol in sever sepsis was obviously higher than those in mild sepsis group?52.72(28.02-61.29)?g/dl vs 20.30(13.27-30.93)?g/dl, P<0.01?. Ac Cording to the prognosis,the differences of COR, between the sepsis death group and the survival group were statistically significant ? 56.42( 38.00-61.90) ?g/dl vs 23.83(14.39-31.90)?g/dl, P<0.01?.2.The level of serum Cortisol was positively Correlated with PCT and LAC,but negatively Correlated with PCIS after analisy by Spearman.3.As to serum Cortisol at three points, the AUC of ROC curve were0.876?0.904?0.914?0.938 respectively.4.Ac Cording to Logistic regression analysis,the COR had independent affect with the prognosis of sepsis patients.5.The circadian rhythm of Cortisol was present in control group and mild sepsis group but absent in sever sepsis group.Conclusion:Serum Cortisol continuously evaluated in the sever sepsis with loss the circadian rhythm. Early plasma Cortisol levels of sepsis patients is associated with the severity of disease, as an independent risk factor to determine the prognosis of patients with sepsis...