RESUMEN
Background: Adrenal insufficiency has been documented in critically ill adults and in children with meningococcal disease. Use of corticosteroids is gaining more popularity in adults with sepsis and septic shock with no clear guidelines for their use in children
Objective: To evaluate serum levels of cortisol and aldosterone in children with sepsis and septic shock, and to evaluate association of these levels with, fluid bolus requirement, inotrope requirements, and mortality
Design: Prospective investigational study conducted on children admitted to the twelve-bed paediatric intensive care unit at St. Mary's Hospital, London, UK
Patients and Methods: Nineteen children with sepsis and septic shock, excluding those with meningococcal disease, were enrolled [group A]. Twenty three children with illnesses other than sepsis [group B] were considered as a control group. The two groups were matched for severity of illness by PRISM-III score. Adrenal function was assessed by basal serum levels of cortisol and aldosterone. Data collected also included blood levels of potassium, sodium, osmolarity, and glucose on admission: level of inotrope support; amount of fluid boluses: and outcome
Results: Children in group [A] had lower cortisol and aldosterone levels than those in group [B]. Lower serum cortisol in group A was associated with higher fluid and inotrope requirement. Serum cortisol levels were lower in non survivors without statistical significance. Serum aldosterone levels were significantly lower in children with higher risk of mortality
Conclusion: Depressed adrenal function is associated with higher morbidity and mortality in children with sepsis and septic shock. Higher fluid and inotrope requirement may define the subset of patients with potential benefit from corticosteroid replacement