Total and high-affinity corticosteroid-binding globulin depletion in septic shock is associated with mortality

Clinical Endocrinology
Emily J MeyerDavid J Torpy

Abstract

Corticosteroid-binding globulin (CBG) and albumin transport circulating cortisol. Cleavage of high-affinity CBG (haCBG) by neutrophil elastase at inflammatory sites causes cortisol release into tissues, facilitating immunomodulatory effects. To determine whether depletion of haCBG is related to mortality in septic shock. A single-center prospective observational cohort study of patients recruited with critical illness or septic shock, using serum samples collected at 0, 8, 24, 48 and 72 hours. Serum total and haCBG, and total and free cortisol were assayed directly. Glucocorticoid treatment was an exclusion criterion. Mortality was assessed at 28 days from Intensive Care Unit admission. Thirty septic shock (SS) and 42 nonseptic critical illness (CI) patients provided 195 serum samples. SS/CI patients had lower total CBG, haCBG and low-affinity CBG (laCBG) than controls. Total CBG and haCBG were significantly lower in septic shock patients who died than in those that survived (P < 0.009, P = 0.021, respectively). Total and free cortisol were higher in septic than nonseptic individuals. Free/total cortisol fractions were higher in those with low haCBG as observed in septic shock. However, cortisol levels were not associated with ...Continue Reading

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Citations

Jul 12, 2019·Clinical Endocrinology·Mark S Cooper
Jul 6, 2021·Frontiers in Endocrinology·Martin Brunel WhyteAnne M Umpleby
Jul 27, 2021·Journal of the Endocrine Society·Emily Jane MeyerDavid James Torpy
Jan 5, 2022·Expert Review of Endocrinology & Metabolism·Annabelle G HayesDavid J Torpy

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