Endocrine and metabolic responses in children with meningoccocal sepsis: Striking differences between survivors and nonsurvivors

To get insight in the endocrine and metabolic responses in children with me ningococcal sepsis 26 children were studied the first 48 h after admission. On admission there was a significant difference in cortisol/ACTH levels be tween nonsurvivors (n = 8) and survivors (n = 18). Nonsurvivors showed an i nadequate cortisol stress response in combination to very high ACTH levels, whereas survivors showed a normal stress response with significantly highe r cortisol levels (0.62 us. 0.89 mu mol/L) in combination with moderately i ncreased ACTH levels (1234 vs. 231 ng/L). Furthermore, there was a signific ant difference between nonsurvivors and survivors regarding pediatric risk of mortality score (31 us. 17), TSH (0.97 vs. 0.29 mE/L), T-3 (0.53 us. 0.3 8 nmol/L), reverse T-3 (rT(3)) (0.75 us. 1.44 nmol/L), C-reactive protein ( 34 us. 78 mg/L), nonesterified fatty acids (0.32 us. 0.95 mmol/L), and lact ate (7.3 us. 3.2 mmol/L). In those who survived, the most important changes within 48 h were seen in a normalization of cortisol and ACTH levels, but without a circadian rhythm; a decrease of rT(3) and an increase in the T-3/ rT(3) ratio; and a decrease in the levels of the nonesterified free fatty a cids and an unaltered high urinary nitrogen excretion. At this moment, it i s yet unknown whether the hormonal abnormalities are determining factors in the outcome of acute meningococcal sepsis or merely represent secondary ef fects. Understanding the metabolic and endocrine alterations is required to design possible therapeutic approaches. The striking difference between no nsurvivors and survivors calls for reconsideration of corticosteroid treatm ent in children with meningococcal sepsis.