Time-dependence of dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate (DHEAS), and cortisol in survivors and non-survivors of severe sepsis
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KeywordsAndrogen Severe Sepsis DHEA DHEAS ACTH Level
The adrenal-derived androgens dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulfate (DHEAS) have important immunoactivating properties. They show a considerable decrease with increasing age. In contrast, cortisol is an endogenous immunosuppressing hormone. Both activation and suppression of immune responses are crucial events during sepsis.
Twenty-eight non-surgical patients with severe sepsis (ACCM/ SCCM criteria, 15 survivors (mean age 53 ± 17, APACHE III score 63.5 ± 7.5) and 13 non-survivors (61 ± 15 years, APACHE III score 64.3 ± 10.4) were included. Hormones were compared at fulfillment of sepsis criteria and time of recovery/death intra-individually as well as between survivors and non-survivors.
During early sepsis, cortisol levels (nmol/l) were higher in survivors than non-survivors (761 ± 120 vs 356 ± 78, P < 0.02) and they decreased in survivors (P < 0.009) during late sepsis. During early sepsis, DHEAS levels (% of age-matched normal levels) were significantly higher in survivors than non-survivors (80± 21 vs 18 ± 5, P < 0.009). They decreased in survivors (P = 0.0002) but remained low in non-survivors during late sepsis. In contrast, during early sepsis, DHEA levels (% of age-matched normal levels) were significantly elevated in survivors compared to non-survivors (289 ± 46 vs 123 ± 31, P < 0.007). They decreased in survivors (P = 0.002) but increased in non-survivors (P < 0.04) during late sepsis. ACTH levels did not significantly change.
(1) The observed hormonal changes during course of sepsis seem to be linked to immunoactivation during early and immunosuppression during late sepsis, thus underlining the importance of time-dependence. (2) The changes have prognostic importance and integrate the component of age to prognosis. (3) The concept of relative adrenocortical insufficiency is extended to changes of adrenal androgens. (4) The results may help to define subgroups which benefit from hydrocortisone substitution.