Title: Adrenocortical state in critically ill infants and children with pnuemonia complicated by sepsis and septic shock
Abstract: <b>Background and Aims:</b> Critically ill infants and children with pneumonia complicated by sepsis and septic shock remain a major cause of morbidity and mortality in Paediatric ICU (PICU). These patients may have adrenocortical insufficiency(AI) that justify steroid use. We aimed to assess adrenocortical state (AS) in these patients. <b>Method:</b> AS was assessed in critically ill infants and children with pneumonia complicated by sepsis and septic shock by estimation of cortisol levels at baseline and after high-dose ACTH stimulation in 20 cases and 30 controls. Absolute adrenal insufficiency (AAI) was defined as basal cortisol levels <7 micg/dl and peak cortisol level <18 micg/dl. An increment <9 micg/dL after stimulation was diagnosed as relative adrenal insufficiency (RAI). <b>Results:</b> Twenty cases with pneumonia were admitted to PICU . Their ages ranged from 3 months_ 5 years; 11 males and 9 females, 9 cases had sepsis (45%), 5 cases had severe sepsis (25%) and 6 cases developed septic shock (30%). Overall mortality was 55 %. The mean cortisol level at baseline in cases (57.73 micg/dl) was higher than that of the controls (12.83 micg/dl), p=0.000. The mean cortisol level 60 minutes after ACTH stimulation (79.305micg/dl) was higher than that of the controls ( 32.8 micg/dl) p=0.000. Six cases (30 %) had RAI. Four cases (66.6%) of those with RAI were on inotropic support, mechanical ventilation and died. <b>Conclusion:</b> RAI in cases was associated with higher mortality, inotropic support and mechanical ventilation. Basal and post-stimulation cortisol levels were markedly elevated in cases than controls, thus there was no AAI in cases.
Publication Year: 2019
Publication Date: 2019-09-28
Language: en
Type: article
Indexed In: ['crossref']
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