Endocrine Abstracts

Introduction: Activation of the hypothalamic–pituitary–adrenal axis is critical for adaptation to stress and serious illness. The imbalance between anti-inflammatory activity of cortisol and proinflammatory activity of the androgens, dehydroepiandrosterone (DHEA) and dihydroepiandrosterone sulfate (DHEAS) can be an important predictor factor of mortality in sepsis.

Material and methods: Patients diagnosed of severe sepsis or septic shock admitted to critical unit of Sierrallana Hospital in Torrelavega (Spain). Cortisol, DHEA and DHEAS were determined in the first 24 h of admission and mortality was recorded at 28 days. For each biomarker, area under curve (AUC) and its 95% CI were estimated by using ROC curves. Levels of biomarkers were ordinal categorized in tertiles (T1, T2 and T3), and as association measure odds ratios (OR) with their 95% CI adjusted for age, sex, SOFA and the presence of severe sepsis or septic shock were estimated.

Results: Data were obtained from 72 patients: median age 67.23 (IQR 17.9); 42/72 males (59.7%); 9/72 mortality at 28 days (12.7%). Predictive accuracy of biomarkers was: AUC total cortisol 0.74; 95% CI (0.55–0.93). AUC DHEA 0.55; 95% CI (0.34–0.76); AUC DHEAS 0,65 (0.50–0.79); AUC cortisol/DHEA 0.74 (0.55–0.92); AUC cortisol/DHEAS 0.79 (0.65–0.94). With regard to the risk of mortality for the patients at the higher tertil (T3) in comparison with the lower tertile (T1), the associations were: OR (total cortisol)=3.24 (0.56–18.76). OR (total cortisol/DHEA)=10.00 (1.10–90.59). OR (total cortisol/DHEAS)=4.17 (0.80–21.85). The results were not affected after adjusting for age, sex, SOFA scale or diagnosis of severe sepsis or septic shock.

Conclusion: Our results suggest that markers of adrenal function are independent predictors of mortality in patients with severe sepsis or septic shock. The predictive ability discriminated by the AUC of the ROC curve is higher for the ratios cortisol/DHEA and cortisol/DHEAs that for isolated values.