Effect of stress doses of hydrocortisone on S-100B vs. interleukin-8 and polymorphonuclear elastase levels in human septic shock
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Thomas Mussack
Abstract
Stress doses of hydrocortisone are known to have immunomodulatory effects in patients with hyperdynamic septic shock. The prognosis correlates with the presence and severity of septic encephalopathy. However, neurological evaluation is influenced by the use of analgesia sedation during artificial ventilation. The objective of this study was to demonstrate the effect of stress doses of hydrocortisone during the initial phase of human septic shock on the serum values of the neurospecific protein S-100B in comparison to the inflammation markers interleukin (IL)-8 in serum and polymorphonuclear (PMN) elastase in plasma. A total of 24 consecutive patients, who met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock, were enrolled in this prospective, randomized, double-blind, single-center trial. The severity of illness at recruitment was graded using the Acute Physiology and Chronic Health Evaluation II and the Simplified Acute Physiology Score II scoring systems. Multi-organ dysfunction syndrome was described by the Sepsis-related Organ Failure Assessment (SOFA) score. All patients were prospectively randomized to receive either stress doses of hydrocortisone or placebo. Hydrocortisone was started in 12 patients with a loading dose of 100mg and followed by a continuous infusion of 0.18mg/kg/h for 6days. Median S-100B serum levels of the hydrocortisone group decreased from 0.32ng/mL at study entry to 0.07ng/mL 6days later without significant differences compared to the placebo group. Initial IL-8 serum levels were significantly higher in the hydrocortisone group up to 12h after study entry, and significantly decreased from 715 to 17pg/mL at the end of the observation period. Median PMN elastase plasma levels were not affected by hydrocortisone infusion. Patients with initial S-100B serum levels >0.50ng/mL revealed significantly higher SOFA scores up to 30h, IL-8 serum levels up to 12h, and PMN elastase plasma levels up to 36h after study entry than those patients with ≤0.50ng/mL. These effects were independent of the amount of fluid correction for hemodilution. Starting S-100B, IL-8 and PMN elastase values of the hydrocortisone group were within the ranges already known in patients with out-of-hospital cardiac arrest or severe traumatic brain injury. Stress doses of hydrocortisone resulted in a significant reduction in IL-8 serum, but not in S-100B serum and PMN elastase plasma concentrations in patients with hyperdynamic septic shock. For the first time, a similar extent of S-100B increase in serum of septic patients at the time of diagnosis was shown as reported for cardiac arrest or severe traumatic brain injury.
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©2005 by Walter de Gruyter Berlin New York
Articles in the same Issue
- Effect of stress doses of hydrocortisone on S-100B vs. interleukin-8 and polymorphonuclear elastase levels in human septic shock
- Conjugated linoleic acid suppresses the secretion of atherogenic lipoproteins from human HepG2 liver cells
- Determination of debrisoquine and 4-hydroxydebrisoquine by high-performance liquid chromatography: application to the evaluation of CYP2D6 genotype and debrisoquine metabolic ratio relationship
- Assessment of iodine intake in mildly iodine-deficient pregnant women by a new automated kinetic urinary iodine determination method
- Butyrylcholinesterase activity and metabolic syndrome in obese patients
- The non-thyroidal illness syndrome after coronary artery bypass grafting: a 6-month follow-up study
- Advanced oxidation protein products (AOPP) for monitoring oxidative stress in critically ill patients: a simple, fast and inexpensive automated technique
- Quality control in urinary stone analysis: results of 44 ring trials (1980–2001)
- External Quality Assessment in The Netherlands: time to introduce commutable survey specimens. Lessons from the Dutch “Calibration 2000” project
- Evaluation of a high-sensitivity turbidimetric immunoassay for serum C-reactive protein: application to the study of longitudinal changes throughout normal pregnancy
- A quantitative appraisal of interference by icodextrin metabolites in point-of-care glucose analyses
- Preanalytical variability in laboratory testing: influence of the blood drawing technique
- Soluble transferrin receptor and transferrin receptor-ferritin index in iron deficiency anemia and anemia in rheumatoid arthritis
- Elevated plasma cysteinylglycine levels caused by cilastatin-associated antibiotic treatment
- The number of consultant clinical chemists in the 15-nation European Union
- Biological variation of vascular endothelial growth factor
- Terminology, categories and representation of examinations in laboratory medicine
- Reply to W.G. Wood. Questionable results – who directs the EQAS organisers? Clin Chem Lab Med 2004;42:1073
- The predictive power of serum κ/λ ratios for discrimination between monoclonal gammopathy of undetermined significance and multiple myeloma
- 4th Conference on Hyperhomocysteinemia: Saarbrücken, Germany, April, 14–16, 2005, Saarland University
Articles in the same Issue
- Effect of stress doses of hydrocortisone on S-100B vs. interleukin-8 and polymorphonuclear elastase levels in human septic shock
- Conjugated linoleic acid suppresses the secretion of atherogenic lipoproteins from human HepG2 liver cells
- Determination of debrisoquine and 4-hydroxydebrisoquine by high-performance liquid chromatography: application to the evaluation of CYP2D6 genotype and debrisoquine metabolic ratio relationship
- Assessment of iodine intake in mildly iodine-deficient pregnant women by a new automated kinetic urinary iodine determination method
- Butyrylcholinesterase activity and metabolic syndrome in obese patients
- The non-thyroidal illness syndrome after coronary artery bypass grafting: a 6-month follow-up study
- Advanced oxidation protein products (AOPP) for monitoring oxidative stress in critically ill patients: a simple, fast and inexpensive automated technique
- Quality control in urinary stone analysis: results of 44 ring trials (1980–2001)
- External Quality Assessment in The Netherlands: time to introduce commutable survey specimens. Lessons from the Dutch “Calibration 2000” project
- Evaluation of a high-sensitivity turbidimetric immunoassay for serum C-reactive protein: application to the study of longitudinal changes throughout normal pregnancy
- A quantitative appraisal of interference by icodextrin metabolites in point-of-care glucose analyses
- Preanalytical variability in laboratory testing: influence of the blood drawing technique
- Soluble transferrin receptor and transferrin receptor-ferritin index in iron deficiency anemia and anemia in rheumatoid arthritis
- Elevated plasma cysteinylglycine levels caused by cilastatin-associated antibiotic treatment
- The number of consultant clinical chemists in the 15-nation European Union
- Biological variation of vascular endothelial growth factor
- Terminology, categories and representation of examinations in laboratory medicine
- Reply to W.G. Wood. Questionable results – who directs the EQAS organisers? Clin Chem Lab Med 2004;42:1073
- The predictive power of serum κ/λ ratios for discrimination between monoclonal gammopathy of undetermined significance and multiple myeloma
- 4th Conference on Hyperhomocysteinemia: Saarbrücken, Germany, April, 14–16, 2005, Saarland University
