Cortisol Levels and Mortality in Septic Shock ICU Patients

Ankara Etlik City Hospital183 enrolled

Overview

This prospective observational study aims to evaluate the prognostic value of cortisol levels and their dynamic changes in critically ill patients with sepsis and septic shock admitted to the intensive care unit. Cortisol plays a crucial role in maintaining hemodynamic stability and modulating the inflammatory response during critical illness, and relative adrenal insufficiency has been associated with worse clinical outcomes. Adult patients admitted to the intensive care unit with sepsis or septic shock will be enrolled and followed prospectively. Serum cortisol levels will be measured, and their association with clinical outcomes, including intensive care unit mortality, 28-day mortality, and 90-day mortality, will be analyzed. In addition, the relationship between cortisol levels and disease severity scores such as SOFA and APACHE, as well as laboratory parameters including inflammatory biomarkers, will be evaluated. The findings of this study are expected to contribute to the early identification of high-risk patients and improve prognostic assessment in critically ill patients with sepsis and septic shock.

Study Type

OBSERVATIONAL

Enrollment

183

Conditions

Sepsis Septic Shock

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 18 years or older * Admission to the intensive care unit for more than 24 hours * Presence of a clinically or microbiologically confirmed source of infection * Diagnosis of sepsis or septic shock during ICU stay Exclusion Criteria: * Pregnancy * Known disorders of the hypothalamic-pituitary-adrenal (HPA) axis * Known disorders affecting cortisol secretion 4.Long-term systemic glucocorticoid use (≥3 months)

Outcomes

Primary Outcomes

1.ICU mortality

1\. ICU Mortality Measure: All-cause mortality during ICU stay Description: The proportion of patients who die during their stay in the intensive care unit

Time frame: During the first 28 days of ICU stay; if the patient is discharged from the ICU to the ward or dies earlier, the follow-up period will end at that time.

28 day mortality

The proportion of patients who die within 28 days following ICU admission

Time frame: Up to 28 days after ICU admission

90 day mortality

The proportion of patients who die within 90 days following ICU admission

Time frame: Up to 90 days after ICU admission

Secondary Outcomes

Length of ICU stay

Duration of hospitalization in the intensive care unit

Time frame: The duration of ICU stay will be evaluated. Although this period may vary for each patient, ICU stay is expected to end within the first 28 days for most patients. Longer ICU stays will continue to be followed and recorded in days.

Mechanical Ventilation Requirement

Whether the patient requires invasive or non-invasive mechanical ventilation

Vasopressor Requirement

Use of vasopressor agents to maintain hemodynamic stability

Sequential Organ Failure Assessment (SOFA) score

Assessment of organ dysfunction severity using SOFA score

Time frame: The occurrence of septic shock during ICU stay will be evaluated. Although the timing may vary for each patient, septic shock is expected to occur within the first 28 days for most patients. If the duration extends beyond 28 days, follow-up will continue

APACHE II score

Assessment of disease severity at ICU admission

Association between cortisol levels and laboratory parameters

Relationship between cortisol levels and laboratory markers including CRP, procalcitonin, lactate, ferritin, WBC, and albumin