Severe Sepsis Clinical Trial
Official title:
Comparison of Total, Salivary and Calculated Free Cortisol Levels in Patients With Severe Sepsis
Background: The purpose of the present study was to compare serum total cortisol (STC),
salivary cortisol (SaC) and calculated free cortisol (cFC) levels at the baseline and after
the ACTH stimulation test, in patients with severe sepsis (SS) and to determine the
suitability of SaC and cFC levels instead of STC for the diagnosis of adrenal insufficiency
in patients with SS.
Methods: Thirty patients with SS (15 men, and 15 women) were compared with 16 healthy
controls. Low dose ACTH stimulation test (1 µg) was performed on the first, 7th and 28th
days of diagnosis of SS. STC and SaC levels were measured during ACTH stimulation test.
More than 90% of circulating cortisol is predominantly bound to cortisol binding globulin
(CBG), but also albumin. Thus, in the presence of both hypoalbuminemia and decreased CBG
levels, the ratio of bound to free cortisol levels can be altered. In this situation,
measurement of FC becomes more important. Direct FC measurement is time consuming and
non-automated. Thus, some indirect methods to determine FC levels had been introduced. The
Coolens' method may be practical to determine FC, it estimates FC levels from STC and CBG
levels. In patients with CI, the synthesis of CBG and albumin is reduced leading to
overestimation of adrenal insufficiency if we only use STC levels. Since some studies
demonstrated that salivary cortisol (SaC) reflect free or unbound plasma cortisol levels,
this method is used more often in clinical studies. STC and SaC levels at baseline and after
ACTH stimulation had been used in some studies in patients with critical illness.
The aim of the present study was to compare STC, SaC and calculated free cortisol (cFC)
levels at baseline and after the ACTH stimulation test in patients with SS and determine the
suitability of SaC and cFC levels instead of STC for the diagnosis of adrenal insufficiency
in patients with SS. And secondary aims of this study was to compare these parameters in
patients with SS with healthy controls and check their effects on survival status of the
patients.
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Observational Model: Case Control, Time Perspective: Prospective
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