• Diane Lipiner-Friedman, Charles L Sprung, Pierre François Laterre, Yoram Weiss, Sergey V Goodman, Michael Vogeser, Josef Briegel, Didier Keh, Mervyn Singer, Rui Moreno, Eric Bellissant, Djillali Annane, and Corticus Study Group.
• Service de Réanimation, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), Garches, France.
• Crit. Care Med. 2007 Apr 1;35(4):1012-8.

ObjectiveTo refine the value of baseline and adrenocorticotropin hormone (ACTH)-stimulated cortisol levels in relation to mortality from severe sepsis or septic shock.DesignRetrospective multicenter cohort study.SettingTwenty European intensive care units.PatientsPatients included 477 patients with severe sepsis and septic shock who had undergone an ACTH stimulation test on the day of the onset of severe sepsis.InterventionsNone.Measurements And Main ResultsCompared with survivors, nonsurvivors had higher baseline cortisol levels (29.5 +/- 33.5 vs. 24.3 +/- 16.5 microg/dL, p = .03) but similar peak cortisol values (37.6 +/- 40.2 vs. 35.2 +/- 22.9 microg/dL, p = .42). Thus, nonsurvivors had lower Deltamax (i.e., peak cortisol minus baseline cortisol) (6.4 +/- 22.6 vs. 10.9 +/- 12.9 microg/dL, p = .006). Patients with either baseline cortisol levels <15 microg/dL or a Deltamax ConclusionsAlthough delta cortisol and not basal cortisol level was associated with clinical outcome, further studies are still needed to optimize the diagnosis of adrenal insufficiency in critical illness. Etomidate influenced ACTH test results and was associated with a worse outcome.

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