Gülbin BIKMAZ AYGENCEL, Nuri ÇAKIR, Leyla TALAN, Melda Aybar TÜRKOĞLU

Septik Şok ile İzlenen Hastalarda, Plazma Kortizol Düzeyinin ve Steroid Tedavisinin Mortalite Üzerine Etkileri

Amaç: Vazopressör tedaviye yanıtsız septik şoktaki hastalarda steroid tedavisiyle hemodinamik yanıtın düzeldiği gösterilmiş olup; bu durum kritik hastalık ilişkili adrenal yetmezlik olarak adlandırılmıştır. Bu nedenle sıvı ve vasopressör tedavisine yanıtsız septik şokta steroid tedavisi birçok çalışmada ve uluslararası kılavuzlarda yerini almıştır. Bu çalışmada septik şok ile izlenen hastalarda plazma kortizol düzeyleri ve steroid tedavisinin yoğun bakım mortalitesi üzerine etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Şubat 2008- Ekim 2010 tarihleri arasında Gazi Üniversitesi Tıp Fakültesi İç Hastalıkları Yoğun Bakım Ünitesi'nde septik şok tanısı ile izlenmiş hastalar retrospektif olarak incelendi. Şok başlangıcında kortizol düzeyi bakılan ve steroid başlanan hastalar çalışma grubu olarak alındı. Yaşları, cinsiyetleri, yoğun bakım ünitesinde yatış süreleri, mekanik ventilasyon ihtiyacı, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE)II skoru ve Glasgow koma skoru, albümin, C reaktif protein(CRP), spot kan şekeri değerleriyle günlük insülin dozları kaydedildi. Sonlanım noktaları olarak şoktan çıkış, yoğun bakım kalış süresi ve mortalite seçildi. Bulgular: Toplam 91 hasta çalışmaya alındı. Hastalar plazma kortizolü 15µgr/dL olanlar olarak iki gruba ayrıldı.Hastaların 22'sinde (%24,2) plazma kortizol düzeyi 15µg/dL olan grupta istatiksel olarak anlamlı şekilde yüksek saptandı. Hastalar steroid tedavisi alıp almamaları açısından kıyaslandı. Sağkalım açısından farklılık gözlenmezken steroid alan grubun yoğun bakım kalış süreleri daha kısa bulundu. Sonuç: Plazma kortizol düzeyi >15µg/dL olan septik şoklu hastalarda yoğun bakım mortalitesi,

Effects of Plasma Cortisol Levels and Corticosteroid Therapy on Mortality in Septic Shock Patients

Objective: In patients with refractory septic shock corticosteroid therapy has been shown to improve hemodynamic instability. This has been named as critical illness related adrenal insufficiency. Several studies had been done on significance of corticosteroid treatment in vasopressor dependent patients. As well it is recommended in guidelines. The aim of this study was to study the effects of plasma cortisol levels and corticosteroid therapy on intensive care unit(ICU) mortality of the patients. Material and methods: Patients who were hospitalized with septic shock at Gazi University Faculty of Medicine medical intensive care unit between February 2008- October 2010 were rewieved retrospectively. Patients whose cortisol levels were measured and corticosteroid treatment was started at the begining of septic shock state enrolled. Age, sex, length of ICU stay, need for mechanical ventilation, APACHE II and glascow score, albumin, C reactive protein, spot blood sugar levels and daily insulin doses were recorded. Length of ICU stay, mortality and reversal of septic shock were choosen as the end points of the study. Results: Totally 91 patients were enrolled. Patients were grouped into two; according to their plasma cortisol levels (15?g/dL). In 22 patients (24,2 %) plasma cortisol level was 15?g / dL group, independent of steroid treatment, ICU mortality rate was significantly higher. Patients were grouped depending on whether they received steroid treatment. There was no mortality difference but in the steroid treatment group length of stay in ICU was significantly shorter. Conclusion: Patients whose plasma cortisol levels were >15 ?g/dL had higher ICU mortality. Corticosteroid treatment was associated with shorter length of ICU stay.

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