Corticosteroid-Binding Globulin Deficiency Independently Predicts Mortality in Septic Shock.
J Clin Endocrinol Metab
; 107(6): 1636-1646, 2022 05 17.
Article
em En
| MEDLINE
| ID: mdl-35152290
ABSTRACT
CONTEXT Hydrocortisone administration in septic shock remains controversial. Corticosteroid-binding globulin (CBG) transports cortisol to inflammatory sites and is depleted in septic shock. OBJECTIVE:
To determine whether severely deficient serum CBGâ <â 200 nmol/L (reference range 269-641 nmol/L) independently predicts septic shock mortality.METHODS:
A prospective observational study in patients with septic shock. Patients were categorized into 2 groups mean plasma CBG concentrations <200 nmol/L and ≥200 nmol/L (day 1/2), with additional categorization by nadir CBG. Primary outcome was intensive care unit (ICU) mortality. Secondary outcomes were 28- and 90-day mortality, norepinephrine requirements, renal replacement therapy, and clinician-instituted hydrocortisone.RESULTS:
135 patients were included. Mortality rates in ICU were higher in the CBGâ <â 200 nmol/L vs the CBGâ ≥â 200 nmol/L group 32.4% vs 13.9% [odds ratio (OR) 2.97 (95% CI 1.19, 7.41); Pâ =â 0.02] with 28-day mortality OR 2.25 (95% CI 0.99, 5.11) and 90-day mortality OR 2.21 (95% CI 0.99, 4.91). Multivariate analysis revealed 4 factors independently associated with ICU mortality CBGâ <â 200 nmol/L (adjusted OR 3.23, 95% CI 1.06, 9.88), Acute Physiology and Chronic Health Evaluation IIâ >â 25 (adjusted OR 3.58, 95% CI 1.20, 10.68), Sequential Organ Failure Assessment (SOFA) liver score (adjusted OR 1.98, 95% CI 1.04, 3.72), and renal replacement therapy (adjusted OR 6.59, 95% CI 2.17, 20.01). Nadir CBG levels were associated with higher SOFA cardiovascular scores and norepinephrine total dose (µg; Pâ <â 0.01) and duration (days; Pâ <â 0.01). Plasma cortisol concentrations and hydrocortisone administration did not relate to ICU mortality.CONCLUSION:
Septic shock patients with CBGâ <â 200 nmol/L had higher norepinephrine requirements and 3.2-fold higher ICU mortality. CBG concentration was the only directly reversible independent mortality risk factor.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Choque Séptico
/
Transcortina
/
Fadiga
/
Doenças Genéticas Inatas
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article