Evaluación de la función adrenal en el paciente con sepsis o shock séptico. Cortisol y andrógenos adrenales como marcadores pronósticos de mortalidad

Abstract

Objective: To determine the prognostic value of cortisol, Dehydroepiandrosterone (DHEA) and Dehydroepiandrosterone-sulfate (DHEAS), and their ratios (Cortisol/DHEA and Cortisol/DHEAS), as independent predictors of mortality in septic patients. Results: Cortisol showed AUCs of 0.758, 0.759 and 0.705 far in-hospital, 28 days and 90 days mortality respectively . Associations between high cortisol levels (>17.5 µ g/dL) and mortality were strong and st at isticall y significant far in-hospital and 28-day mortality: adjusted ORs 10.13 and 9.45 respectively, and lower far long term mortality {90 days): adjusted OR 4.26 (95% CI 1.34-13.56), p trend 0.014. Regarding adrenal androgens, only positive associations were obtained far DHEAS and most of these posit ive associations did not yield st atist ical si gnificance. Regarding Cortisol/DHEA and cortisol/ DHEAS ratios, they did not improve the predictive ability of cortisol. The exception was the cortisol/DHEAS ratio, which turned out to be the best predictor of mortality at 90 days (AUC 0.737), adjusted OR far highest cortisol/DHEAS ratio values 6.33 (95%CI 1.77-22.60), p trend 0.002. Conclusion: Basal cortisol measured in the first 24 hours of the sept ic process was the best prognostic factor far in-hospital and 28-day mortality, even superior to SOFA or APACHE 11 seores. The cortisol/DHEAS ratio was an independent predictor far long-term mortality.