Prognostic significance of serum cortisol in catecholamine-resistant pediatric shock

Abstract

Objective: To determine prevalence of adrenal insufficiency in catecholamine-resistent pediatric shock; and to study association between serum cortisol level and severity of illness in catecholamine resistant pediatric shock. Study design: Prospective observational study Setting: Pediatric intensive care unit in a tertiary care hospital. Patients: 114 pediatric patients with catecholamine refractory shock. Interventions: Serum cortisol and outcome parameters of mortality, vasoactive inotropic score, Pediatric Risk of Mortality Score and mechanical ventilation rate were recorded. Results: The prevalence of adrenal insufficiency in our study was 14.03%. Mortality as primary outcome variable was significantly correlated to age (0.737), weight (0.291), adrenal insufficiency (0.354), Pediatric Risk of Mortality Score (0.677), and vasoactive inotropic score (0.268). Increase in age, higher incidence of adrenal insufficiency and Pediatric Risk of Mortality Score were associated with the highest odds of dying with 13.7(95% CI, 0.2-943), 2.36 (95% CI, 1.86-2.82) and 1.47 (95% CI, 1.16-1.86) respectively. Overall, the outcome variables were significant in patients with adrenal insufficiency and those with unusually high adrenal cortisol response. Conclusion: We concluded, adrenal response is varied in a wide spectrum of disease conditions in critically ill children. Both low and abnormally high cortisol response to acute illness is associated with poor clinical outcome in the form of high mortality, increased need for catecholamines and higher rates of mechanical ventilation.