TIME-COURSE AND VARIABILITY OF THE ENDOCRINE AND METABOLIC RESPONSE TO SEVERE SEPSIS

Background. In trauma patients a specific pattern of the hormonoendocr ine response to injury has been described. Conflicting data exist rega rding the hormonal changes during sepsis. We studied the time course a nd variability of the hormonal and metabolic responses to severe sepsi s in twelve medical patients. Methods. Hormone levels were measured ev ery 6 hours. Urinary nitrogen and 3-methylhistidine excretion were mea sured daily. Indirect calorimetry was used to calculate energy product ion rate (EPR). Results. None of the hormones measured showed a time c ourse in individual patients. Growth hormone (1.69 +/- 0.17 ng/ml) and insulin (48 +/- 5 mU/L) values were within normal range. Cortisol val ue (474 +/- 44 nmol/L) was in the upper normal range. Insulin-like gro wth factor 1 level (12.5 +/- 5.7 nmol/L) was decreased. Nitrogen balan ce was negative and did not change during the study period. Neither ox ygen consumption (VO2) (318 +/- 20 ml/min), carbon dioxide output (283 +/- 10 ml/min), EPR (2064 +/- 435 kcal/day), nor fuel utilization sho wed a time course. The variability during the study period compared wi th values on admission ranged from 20% (insulin-like growth factor 1) to 74% (growth hormone). The variability of calculated fuel utilizatio n ranged from 35% (protein) to 180% (fat). The variability of VO2, car bon dioxide production, and EPR was far less, 8%. Conclusions. A speci fic pattern in the endocrine and metabolic responses as observed in tr auma patients does not occur in medical patients with severe sepsis. H ormones and calculated fuel utilization show large variations when com pared with values on admission. VO2 and EPR vary far less. Nutritional needs in patients with sepsis, therefore, can be calculated on admiss ion and need not be recalculated during the first week after admission .