PURPOSE: Septic shock (SS) is one of the leading causes of death in critically ill patients. The prognostic value of random cortisol concentration in sepsis remains a controversial issue. Patients with SS may have lower basal cortisol levels (BCL) compared to the healthy population. In addition, the prevalence of myocardial injury is found to be increased in patients with SS. We evaluated the relationship between low BCL and cardiac injury in patients with SS.
METHODS: In this retrospective study we reviewed 136 patients who had documented SS. All patients had cardiac biomarkers measured on admission to rule out myocardial injury. Troponin I ≥ 0.40 ng/ml and creatinine kinase (CK) MB fraction greater than our reference standard were considered abnormal. All patients were also tested for BCL within 24 h of admission. BCL less than 15 μg/dl, is considered abnormal for patients in SS.
RESULTS: Among 136 patients with SS, 53 patients (39%) had abnormal BCL. In this group of patients 12 patients (22.6%) had abnormal cardiac enzymes. The remaining 83 patients (61%) had normal BCL on admission. In this group only 3 patients (3.6%) had abnormal cardiac enzymes. Chi-Square analysis demonstrated a significant difference in the prevalence of cardiac injury between patients with normal and abnormal BCL (P ≤; 0.001).
CONCLUSION: This is the first study demonstrating a significant univariate relationship between low plasma cortisol level and the prevalence of cardiac injury in patients with septic shock. Further multivariate analysis controlling for other prognostic factors is necessary to confirm this finding in a larger study.
CLINICAL IMPLICATIONS: Low BCL is associated with increased incidence of cardiac injury. Whether this is a casual relationship remains to be determined, and may have future implications for therapeutic interventions.
DISCLOSURE: Ghulam Mujtaba, None.