Ders to the low-dose synacthen test. Non-responders had drastically greater IL-6 levels in comparison to

Ders to the low-dose synacthen test. Non-responders had drastically greater IL-6 levels in comparison to responders (76.6 vs 37.3 pg/ml, P = 0.01). General, 18 patients died and 25 patients survived to hospital discharge. Non-survivors had significantly reduced baseline (15.1 ?2.9 vs 18.0 ?four.5 /dl, P = 0.02) and stimulated (19.1 ?3.3 vs 23.0 ?5.six, P = 0.01) cortisol levels in comparison to survivors. In conclusion, sufferers with protracted vital illness could have an altered adrenal responsiveness to stimulation by ACTH. This discovering is in portion explained by an increase in the production of IL-6 and carries a poor prognosis.P224 Time-dependence of dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate (DHEAS), and cortisol in survivors and non-survivors of serious sepsisC Marx*, S Petros, SR Bornstein, M Wendt*, L Engelmann, G Hoeffken* *Department of Internal Medicine I, University Hospital C.G. Carus, Fetscherstra 74, 01307 Dresden, Germany; Health-related ICU, University of Leipzig, Germany; Department of Endocrinology, Heinrich-Heine-Universitat D seldorf, Germany Objective: The adrenal-derived androgens dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulfate (DHEAS) have crucial immunoactivating properties. They show a considerable decrease with TMP195 manufacturer rising age. In contrast, cortisol is an endogenous immunosuppressing hormone. Each activation and suppression of immune responses are crucial events throughout sepsis. Patients: Twenty-eight non-surgical individuals with severe sepsis (ACCM/ SCCM criteria, 15 survivors (mean age 53 ?17, APACHE III score 63.five ?7.5) and 13 non-survivors (61 ?15 years, APACHE III score 64.3 ?10.four) had been included. Hormones had been compared at fulfillment of sepsis criteria and time of recovery/death intra-individually at the same time as between survivors and nonsurvivors. Benefits: During early sepsis, cortisol levels (nmol/l) were greater in survivors than non-survivors (761 ?120 vs 356 ?78, P < 0.02) and they decreased in survivors (P < 0.009) during late sepsis. During early sepsis, DHEAS levels ( of age-matched normal levels) were significantly higher in survivors than non-survivors (80 ?21 vs 18 ?5, P < 0.009). They decreased in survivors (P = 0.0002) but remained low in non-survivors during late sepsis. In contrast, during early sepsis, DHEA levels ( of age-matched normal levels) were significantly elevated in survivors compared to non-survivors (289 ?46 vs 123 ?31, P < 0.007). They decreased in survivors (P = 0.002) but increased in non-survivors (P < 0.04) during late sepsis. ACTH levels did not significantly change. Conclusions: (1) The observed hormonal changes during course of sepsis seem to be linked to immunoactivation during early and immunosuppression during late sepsis, thus underlining the importance of time-dependence. (2) The changes have prognostic importance and integrate the component of age to prognosis. (3) PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20724562 The notion of relative adrenocortical insufficiency is extended to alterations of adrenal androgens. (4) The results might enable to define subgroups which benefit from hydrocortisone substitution.P225 High incidence of decreased cortisol reserve in brain-dead prospective organ-donorsI Dimopoulou*, A Anthi, E Milou*, I Ilias*, C Stavrakaki*, M Tzanela, S Orfanos*, M Christoforaki, K Mandragos, C Roussos*, S Tsagarakis *Department of Crucial Care Medicine, Evangelismos Hospital, 4 Marasli street, 160 75 Athens, Greece; Division of Vital Care Medicine, Hellenic Red Cross Hospital, Athens, Greece; Depart.