Sepsis When Adrenal Cortical Function

Part I Adrenal Function Changes of Pulmonary Acute Lung Injury in RatsObjective:Study adrenal function changes of pulmonary ALI induced by Escherichia coli (O111B4) in rats. Evaluate low dose corticotrophin-stimulated test value.Methods:ALI model was induced by intratracheal E.coli injection[3ml/kg,O111B4, (4.4-5.6)×1012CFU/L)]. ALI models were then randomly divided into three time series, and every time series had 10 rats. In the control group, saline was administered intratracheally, and every time series had 8 rats. Six hours and twentity-four hours and thirty-six hours later, mechanical ventilation was applied. The post-surgery time course of the plasma corticotropin, corticosterone levels were studies on individual times. Corticosterone after 100ug porcine corticotropin was also measured.Results:After E.coli injection for 3hrs, rats began coughing. At 6hrs, rats tachypnea occurred. And 8hrs later, the rats began to die. At 36hrs,29 rats died. The mortality was 51.61%. In the control group, rats did not die. Plasma corticosterone levels were higher than controls at 6hrs and 24hrs (p<0.01, p<0.05), and plasma corticosterone levels at 36hrs were lower than controls (p<0.05). Concentration in plasma corticosterone at 6 hours reached the highest and was higher than 24hrs after the onset of sepsis. The results indicate that a higher concentration in plasma corticotropin at 6hrs and 36hrs after the onset of sepsis than those in sham-operated animals (p<0.01).At 24hrs concentration of plasma corticotrophin reached the highest (p<0.01). Moreover, the plasma corticosterone of responses to corticotropin of ALI rats was all lower than control group. (6h, p<0.05; 24h,36h, p<0.01). And the increases of 6hrs were higher than those of 24h and 36h.Conclusions:These findings suggest that the plasma corticosterone reached the highest at early stage during ALI rat. At later stage, the respond to corticotrophin decreased. Adrenal insufficiency may occur at early stage of ALI rats, and with the disease developed, the percentage of adrenal insufficiency rats in ALI group increased. Low dose corticotrophin-stimulated test could evaluate adrenal function changes of pulmonary ALI induced by Escherichia coli (O111B4) in rats. Part II The Dynamic Observations on the Changes of Serum Cortisol, MIF, IL-6 and IL-10 Levels in sepsis pigs on Continuous Veno-venous Hemofiltration (CWH)Objective:To explore the dynamic changes of serum levels of COR, MIF, IL-6 and IL-10 Levels in sepsis immature pigs on CVVH. And to evaluate the effect of CVVH.Methods:Sepsis pig was induced by E.coli femoral vein injection [3ml/kg,O111B4, (4.4-5.6)×1012CFU/L)] into twelve healthy male immature pigs. Twelve immature pigs were randomly allocated either to an untreated control group or to the treatment group. The latter underwent Continuous Veno-venous Hemofiltration, which started 0.5 hour later after E.coli femoral vein injection. The post-CVVH time course of the plasma COR, MIF, IL-6 and IL-10 levels were studies at 2hrs,4hrs,6hrs and 8hrs.Results:In the CVVH group, levels of COR were lower than those in the control group at 2hrs,4hrs, and 6hrs after the beginning of CVVH. At 8hrs, the levels were higher than the control group (P＜0.05). The COR level of CVVH, group changed slightly. In the control group, levels of COR increased after E.coli injection and reached the highest at 4hrs, and then gradually dropped. In the CVVH and control group, levels of MIF at 2hrs, 4hrs, and 6hrs were higher than Ohrs. MIF of CVVH group was lower than those in the control group (P< 0.01, P< 0.05). In the CVVH group, levels of MIF increased and reached the highest at 2hrs. But the highest was lower than that of the control group. Levels of MIF in the control group afte E.coli injection increased, and reached the highest at 2hrs. The ratio of MIF to COR dropped obviously after CVVH. The ratios of MIF to COR of CVVH group at 4hrs,6hrs, and 8hrs were lower than those of the control group. Levels of IL-6 in the control group and the CVVH group after E.coli injection were significantly higher than Ohrs. And the levels of IL-6 of CVVH group were lower than those of control group (P<0.05, P＜0.01).. In the CVVH group, levels of IL-6 reached the highest at 4hrs and then dropped evidently.In the control group, levels of IL-6 increased after E.coli injection and reached the highest at 4hrs, and then remain high levels.Levels of IL-10 in the CVVH group at 2hrs,4hrs, and 6hrs after E.coli injection were significantly higher than Ohrs. And the level reached the highest at 2hrs, and then dropped progressively. And the levels at 6hrs and 8hrs were lower than the control group(P<0.05). Levels of IL-10 of control group after E.coli injection were significantly higher than Ohrs. The ratio of IL-10 to IL-6 dropped obviously after CVVH. And the ratio increased at 8hrs. The ratios of IL-10 to IL-6 of CVVH group at 2hrs and 4hrs were lower than control group, and 8hrs were higher than the latter. Conclusions:The CVVH could reduce the serum contents of COR, MIF, IL-6, and IL-10 in sepsis pigs. The CVVH could reduce the mortality of immature pigs with sepsis.PartⅢThe Observations on the Changes of Serum Corticotropin and Cortisol Levels in Children with sepsisObjective:This observational study investigated the changes of serum corticotropin and cortisol levels in children with sepsis, and also investigated the relationship of the levels of corticotropin and cortisol to the prognosis and disease severity of sepsis.Methods:The levels of serum corticotropin and cortisol were measured in 65 children with sepsis within the first 24h of admission into the PICU. The severity of pediatric critical illness score (PCIS) was determined after the admission.20 healthy children were control group. The levels of serum corticotropin and cortisol were compared between mild group and severe group, septic shock group and non septic shock group, and also between death group and survival group.Results:Levels of corticotropin and cortisol of the children with sepsis were higher than those of control group after admmission into the PICU (P＜0.01, P<0.05). With the PCIS decreased, the levels of corticotrophin, cortisol and the ratio of corticotropin to cortisol increased. The levels of corticotropin, cortisol and the ratio of corticotropin to cortisol of mild group were lower than those of the severe group (P<0.01, P<0.05). There were 21 chlidren whose cortisol levels were lower than 18μg/dl in the mild group. And the percentage was 84%. In the severe group, cortisol levels of 27 cases were also lower than 18μg/dl. The two groups were not evidently different. The level of corticotropin of septic shock group was higher than that of the non septic shock group (P＜0.01). But cortisol level was not different from the latter. There were 6 chlidren whose cortisol were lower than 18μg/dl in the shock group. And the percentage was 75%. In the non shock group, cortisol levels of 5 cases were lower than 18μg/dl. The two groups were evidently different (P<0.01). The levels of corticotrophin and cortisol of death group were evidently higher than those of survival group. There were 7 chlidren whose cortisol levels were lower than 18μg/dl in the survival group. And the percentage was 23.3%. In the death group, cortisol levels of 4 cases were lower than 18μg/dl. The two groups were not evidently different (P>0.05). Sixty-five patients with sepsis were included in this study, and the PCIS was 79.60±14.24. PCIS of death group was lower than that of the survival group(60.00±13.69vs82.66±12.19, P<0.01).And the PCIS of septic shock group was evidently different from the non shock group(64.50±12.73vs82.03±13.31, P<0.01).Corticotropin and cortisol were significantly inversely correlated with PCIS after admmission into the PICU.Conclusions:These findings suggest that the plasma corticotropin and cortisol at early stage of sepsis may be correlated with severity of sepsis, and may be also correlated with prognosis. Cortisol level 18μg/dl can not be used for evaluating mild sepsis. But it can be used for evaluating severe sepsis. When cortisol level is lower than 18μg/dl, the patient should be given steroid.