Endocrine Abstracts

JOINT2808

Sepsis is a life-threatening disease posing a huge burden to healthcare systems. It remains one of the most frequent causes of the admissions to hospitals with high mortality of patients. Hence, early identification of patients threatened with worse course of the disease and death is crucial. The activation of hypothalamic–pituitary–adrenal axis is a very important part of organism’s response to ongoing infection. The majority of published papers describes the role of cortisol in septic patients, however, the scarce data regarding androgens are inconclusive. For this prospective study 49 septic patients and 25 healthy controls were recruited. The concentrations of dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS), androstenedione, testosterone, cortisol, sex hormone-binding globulin (SHBG) and 28-day mortality were assessed. The severity of the disease was described as APACHE II (Acute Physiology and Chronic Health Evaluation II) scale and SOFA (Sequential Organ Failure Assessment) score. The data were collected in three time points: up to 24 hours of hospital admission, on the 2nd day of hospital stay and after reaching hemodynamic stability/day of discharge/the day prior/ 8–10th day of prolonged hospitalization. The concentrations of all examined hormones were changing within the course of sepsis (P<0.01). Assessing 28-day mortality, nonsurvivors had higher DHEA in all time points (P: 0.027–0.051) with higher cortisol (p=0.016) and androstenedione (P=0.020) in the first time point. Among indexes, only cortisol/testosterone ratio was different in the first time point (P=0.031). SOFA and APACHE results were lower in survivors in comparison to nonsurvivors. In first time point in both groups – survivors and nonsurvivors – DHEA values were not age-dependent. In third time point in nonsurvivors, contrary to survivors, DHEA concentrations did not change with patients’ age. Additionally, lower BMI (P=0.020; HR=0.8533), higher cortisol (P=0.044; HR=1.001) and higher cortisol/testosterone ratio (P=0.001; HR=1.002) were risk factors for death. In logistic regression, DHEA and cortisol were feasible prognostic factors with AUC 0.71 and 0.73, respectively. In conclusion, DHEA and cortisol can be used as prognostic factors in sepsis. Low BMI, high cortisol and high cortisol/testosterone ratio are the risk factors for death. Androgens show various changes during the course of sepsis that differ between survivors and nonsurvivors groups. Those changes might be used for more thorough assessment of septic patients. However, the role of androgens in severe infection still needs in-depth explanation. Our better understanding of the disease might help define the most time- and cost-effective regimens of sepsis management always having patients’ health in mind.