Correlation between Oesinophilia and Adrenocortical Insufficiency in Sepsis and Septic Shock
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- Category: Vol. 78, December 2010
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Correlation between Oesinophilia and Adrenocortical Insufficiency in Sepsis and Septic Shock,FAROUK MOUSTAFA, MOHAMAD EL-SHAFIE, RANIA EL-HOSEINY and MARWA SHETA
Abstract
Introduction: Sepsis and septic shock are associated with high rate of morbidity and mortality. In some cases, septic shock refractory to IV fluids and vasopressors may be asso-ciated with adrenocortical insufficiency. Oesinophilia is assumed to be a marker of adrenocortical insufficiency. The study was performed to better define the incidence of adreno-cortical insufficiency in sepsis and septic shock, to clarify whether glucocorticoid supplementation is beneficial in patients with septic shock and its effect on mortality and to find whether oesinophilia may be used as a marker of adrenocortical insufficiency in septic shock.
Methods: An observational prospective study was per-formed at Critical Care Department, Cairo University from June 2009 to April 2010, including 13 patients with sepsis and 50 patients with septic shock who required vasopressor therapy after adequate volume resuscitation without previous steroid usage. After measurement of baseline total cortisol, the patients were subjected to ACTH stimulation test (250μg). Post-stimuli cortisol levels were drawn 60 minutes after. Each patient had complete blood count (CBC) to detect oesinophilic count. Patients with AI were given hydrocortisone 100mg/8 hr till improvement. Oesinophilia was defined as oesinophilic count >!3%. AD defined as serum cortisol <20μg/dl with A cortisol (60min. Post ACTH minus baseline) of !99μg/dl. FH defined as serum cortisol <30μg/dl with A cortisol !99μg/dl. AI defined as the presence of either AD or FH.
Results: 63pts; 38 males and 25 females with mean age 56.73±17.39 and APACHE II score 25.78±9.79. Intra-abdominal infections and infected wounds are the most com-mon source (47.6%). CBC showed anemia in 76.2% of pts, lymphopenia in 44.4% and oesinophilia in 15.9%. AI was found in 55.6% (62% in septic shock group and 30.8% in sepsis group) with lower total baseline and stimulated cortisol
Abbreviations:
APACHE II: Acute Physiology and Chronic Health Evaluation score II.
AD : Adrenal Dysfunction.
FH : Functional Hypoadrenalism.
AI : Adrenal Insufficiency.
levels in patients with serum albumin <2.5gm% in relation to patients with serum albumin >2.5gm% (p=0.046). In septic shock group, there was significantly higher incidence of oesinophilia in patients with AI in relation to pts with no AI; specificity 100% (p=0.018). Hyperkalemia was significantly higher in patients with AI (p=0.016). Statistically significant higher incidence of AI was shown by pts with pre-existing liver disease (p=0.026). Thirty five patients received steroid therapy; 48.5% had initial hemodynamic improvement with no significant effect on mortality. Our pts showed significantly higher mortality with (74.3%) AI vs no AI (53.6%) (p=0.074). Overall mortality 65.1% in all pts.
Conclusions: High incidence of AI in septicemia especially in septic shock. Oesinophilia is a specific but not a sensitive marker of AI. Higher mortality in septic shock with AI. No effect of steroid therapy on mortality reduction in septic shock.