The Adrenal Function In Surgical Patients With Sepsis And The Effect Of Low-dose Glucocorticoid Treatment On The Prognosis

Objectives:To investigate the alteration of inflammatory cytokines and adrenal function in surgical patients with sepsis,and the effect of low-dose glucocorticoi treatment on the prognosis.Methods:Twenty five patients with severe sepsis or septic shock were enrolled in this study. all patients met the diagnostic criteria. Patients were designated into treatment group (12 cases) and control group (13cases) randomly. We gived Hydrocortisone 200mg/d for treatmnet group and placebo every 6 hours for control group for 7 days. 25 patients after surgery without sepsis in SICU were collected in the same period. Blood samples of all patients were taken on the first day and seventh day in order to measure adrenocorticotropic hormone(ACTH), cortisol (Cort) and interleukin-6 (IL-6). Made the bivariate correlation about APACHEâ…¡with the concentration of IL-6 and cortisol. Relative adrenal insufficiency (RAI) was defined as the random cortisol concentration<690nmol/l. And observed the incidence of RAI. At the same time, the following parameters in the patients were recorded:age, sex, Acute Physiology and Chronic Health Evaluation (APACHE)II, heart rate(HR), mean arterial pressure (MAP), and laboratory parameters.Results:The serum ACTH, IL-6 and cortisol of sepsis patients were significantly increased to the control group on days 1and 7, there were the statistics differences (P<0.05) between treatment and placebo group when measured the serum ACTH, IL-6 and cortisol on the seventh day in sepsis patients. meanwhile, there were no statistics differences on the level of cortisol and ACTH. Result showed:there were statistics differences on shock reversal rate between treatment and placebo group, but no differences on 28 motality. There were positively correlated on APACHEII with cortisol and IL-6.Conclusion:the levels of serum ACTH, IL-6 and cortisol were significantly increased in sepsis and septic shock patients, can use as a prognosis indicator of sepsis. the glucocorticoids has a effect of inhibition on inflammatory cytokines such as IL-6 and can reduce the time of shock reversal.