الفهرس 
SepsisOnly 14 pages are availabe for public view
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Abstract
Early recognition of sepsis is important because prompt initiation of therapy likely improves outcomes.
In our study 153 patients were enrolled as they were admitted to university intensive care unit [ICU]. Critical ill patients with signs of early sepsis were considered eligible for enrollment in the study.
The patients randomly allocated to one of the three groups: Group A: Low dose Hydrocortisone injection added to their conventional treatment, Group B: Low dose Hydrocortisone infusion added to their conventional treatment, Group C: received conventional therapy for sepsis.
Patients were evaluated in the first day of admission Short Synacthen test has been performed before the start of the treatment, then from the first day of treatment data were collected daily from measuring Serum Cortisol level, C reactive protein [CRP], ScVO2, Liver enzymes, Creatinine, lactate , SOFA score, and general hemodynamic measurements at days 0, 3 and 6. Length of ICU stay, and hospital mortality rate were observed. The incidence of complications was also observed.
Results regarding manifestations of organ dysfunction showed response to hydrocortisone treatment, which was explained by improvement of mean arterial blood pressure, Lactate clearance; CRP and Creatinine significantly decrease in their level in comparison to the control group.
Regarding the effect of corticosteroid therapy on the SOFA score, there was a significantly improvement compared to the control group.
Regarding to the effect of corticosteroid therapy on the hospital mortality rate there was no significant difference between the three groups.
We found that usage of low dose hydrocortisone (300 mg per day eithier IV bolus doses or continious IV infusion) in severe sepsis our study clearly proved this significant benefit as the improvement in both the steroids groups. This could be explained by the improvement basis in manifestations of organ dysfunction, lowering CRP levels, serum lactate clearance and improvement of the SOFA score.
By measuring random free cortisol level in all the studied patients and assessing its diagnostic and prognostic value (marker of severity of the inflammatory state and exhaustion of the HPA axis), we found that it is a highly valid marker in the diagnosis and prognosis of morbidity and mortality in patients with sepsis and that the higher the level of free cortisol the worse the prognosis.
Regarding the incidence of complications related to hydrocortisone therapy results showed no significant difference in their occurrence such as infection fulmination, diabetes, or glaucoma.