ABSTRACT 829

Abstract

Background and aims: The benefit from corticosteroids remains controversial in sepsis and septic shock and the presence of adrenal insufficiency (AI) has been proposed to justify steroid use. Aims: to determine adrenal state and its relation with outcome in critical children admitted with sepsis to PICU of Cairo University, Children Hospital. Methods: Thirty cases with sepsis and septic shock were studied. Cortisol levels (CL) were estimated at baseline and after high-dose short ACTH stimulation in those patients and in matched 30 controls. Absolute AI was defined as basal CL <7 micg/dl and peak CL <18 micg/dl. Relative AI was diagnosed if cortisol increment after stimulation is <9 microg/dL. Results: Overall mortality of cases was 50 %. The mean CL at baseline in cases was higher than that of controls (51.39 micg/dl vs 12.83 micg/dl, p=0.000). The mean CL 60 minutes after ACTH stimulation was higher than that of controls (73.38micg/dl vs 32.80 micg/dl, p=0.000). The median of % rise in cases was lower than that of controls (45.3 % vs 151.7%). There was positive correlation between basal and post-stimulation cortisol with number of system failure, inotropic support duration, mechanical ventilation days, and CO2 level in blood. There was negative correlation between basal and post stimulation cortisol with blood pH and HCO3. Conclusions: RAI is common with severe sepsis/septic shock. It is associated with more inotropic support and has higher mortality. Studies are warranted to determine whether corticosteroid therapy has a survival benefit in children with RAI and catecholamine resistant septic shock.