Korelasi Antara Hormon Kortisol dengan Mortalitas pada Anak Sepsis Berdasarkan Skor Prism IV

Abstract

Sepsis as one of the most common stressful conditions in human body. As the way the body adapts to stress, during sepsis the body activates the hypothalamic-pituitary-adrenal (HPA) axis, resulting in a significant increase in cortisol levels. Cortisol has been linked to mortality. Prolonged elevated cortisol may increase the likelihood of developing adrenal insufficiency. Measuring cortisol levels becomes critical to aid clinicians in providing therapy and predicting prognosis. This research was a prospective study to observe the correlation between cortisol and mortality in septic shock patients. The research was conducted in the pediatric critical care unit at Haji Adam Malik hospital, Medan, North Sumatra, Indonesia from May 2021 to January 2022. PRISM IV score calculation was carried out within the first 24 hours. Cortisol was assessed from blood sampling at 08.00 and t 17.00. The correlation between cortisol and PRISM IV score was analyzed using Pearson correlation test for normal distribution or Spearman correlation test for non-normal distribution. There was a positive correlation between cortisol level and PRISM IV score. Morning cortisol level had p value 0.002 (r=0.442) and afternoon cortisol level had p value <0.001 (r=0.493). The cut-off values for cortisol level to predict mortality differed between morning and afternoon cortisol values, such as 12.3 mcg/dl and 11.2 mcg/dl, respectively. Both morning and afternoon cortisol levels had 67.9% sensitivity, 68.4% specificity, 76.1% positive predictive value (PPV), and 76% and negative predictive value (NPV). The accuracy level of cortisol levels to predict mortality in children with sepsis was 68.1%.