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Master Thesis

Valeur pronostique et déterminants de la cortisolémie et du test au synacthène dans les 24 premières heures du choc septique‎ : étude rétrospective sur 219 patients au CHU de Grenoble

Abstract : Background: Cortisol has a physiopathologic role and a pronostic value which still have to be documented. Critical illness-related corticosteroid insufficiency definition and treatment are still unclear. Aims: Analyze which factors are involved determining plasma cortisol and analyze relationship between plasma cortisol and mortality. Method: Retrospective study including 219 patients with septic shock. Baseline plasma cortisol and 250 μg synacthen stimulation test results have been collected within 24 hours of developing septic shock. In-hospital mortality, and many parameters were analyzed. Results: Baseline plasma cortisol is correlated with SAPSII, with renal dysfunction, PO2 decrease, mean adrenal gland volume. Univariate analysis establishes a correlation between plasma cortisol >34 μg/dl and hospital mortality. There is no linear correlation between baseline plasma cortisol and mortality. Factors determining the response to synacthen stimulation test, with 250 nmol/l used as a threshold, are: hemoglobin, blood glucose level and mean blood pressure. When the criterion used is the median response rate (20%), then determining factors are: lactates, blood glucose level, bacteraemia, PO2/FiO2 ratio and proteinemia. There is no correlation between in-hospital mortality and non-responders patients. Conclusion: Baseline plasma cortisol reflects the septic shock seriousness and is correlated with organ dysfunction markers. Response to the synacthen test is correlated with the sepsis intensity.Furthermore, the adrenal volume is likely to be correlated with baseline plasma cortisol value. There was no correlation between plasma cortisol and in-hospital mortality.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-00724100
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Submitted on : Friday, August 17, 2012 - 2:45:48 PM
Last modification on : Tuesday, May 11, 2021 - 11:36:16 AM
Long-term archiving on: : Sunday, November 18, 2012 - 2:30:53 AM

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Pierre Bonnin. Valeur pronostique et déterminants de la cortisolémie et du test au synacthène dans les 24 premières heures du choc septique‎ : étude rétrospective sur 219 patients au CHU de Grenoble. Médecine humaine et pathologie. 2012. ⟨dumas-00724100⟩

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