In the overall population, in-hospital mortality was significantly associated with female sex and a higher day 1 SAPS II (Table (Table2).2). In-hospital selleck screening library nonsurvivors had significantly higher plasma cortisol levels and lower plasma IGF-1 levels than in-hospital survivors. Mean blood glucose levels between admission and awakening tended to be greater in in-hospital nonsurvivors.Mean blood glucose levels were significantly higher in women who were nonsurvivors. Other plasma hormone levels, as well as the prevalence of SH, did not differ at a statistically significant level between the two groups.In men, plasma levels of DHEA and DHEAS were significantly lower in nonsurvivors. The proportion of men with SH and PH, as well as plasma levels of gonadic hormones and mean blood glucose, did not show a statistically significant difference between the two groups.

DiscussionProtracted critical illness is associated with dysfunction of the neuroendocrine axes and the adrenal gland [5,6,17,19-21], which is characterized by low circulating levels of hypophyseal and adrenal hormones, notably DHEA and DHEAS. In accord with our previous study [11], the present results are consistent with this endocrine pattern, indicating that hormonal status has been assessed at the postacute phase of critical illness.We found that nonsurvivors had increased plasma cortisol levels, suggesting persisting stress. Increased plasma cortisol level was associated with decreased plasma DHEA and DHEAS levels in men who subsequently died, suggesting adrenal exhaustion [22].

Although the association of mortality with adrenal exhaustion has also been reported previously in septic shock [1,2], we do not have any explanation for the fact that it was observed only in men in the present study. Interestingly, neither high circulating cortisol levels nor adrenal exhaustion were related to the administration of corticosteroids, suggesting that corticosteroid therapy has no deleterious effect on adrenal function. This is an important finding, considering the controversy regarding the usefulness of corticosteroids in patients in septic shock [23]. Arlt et al. [1] previously showed a lack of association between DHEA (increased) and DHEAS (decreased) and that mortality was associated with an increased cortisol-to-DHEA ratio. However, these results were obtained when patients were in an early stage of septic shock.

Conversely, Marx et al. [2] measured the plasma levels of adrenocortical hormones in 30 patients at the onset, the halfway point and the last day of sepsis, with a total duration Brefeldin_A of about 9 days. On the last day of sepsis, they found that plasma levels of cortisol and DHEA tended to be higher and those of DHEAS were lower in nonsurvivors. The discrepancy between the DHEA findings between the study by Marx et al.