Dynamic Changes in Serum Cortisol and Acth Levels and Lymphocyte Subset Counts in Children With Septic Shock

Backgroud: To study the dynamic changes in serum cortisol, adrenocorticotropic hormone (ACTH) levels and peripheral blood lymphocyte subset counts in children with septic shock (SS) and to explore their association with the severity and prognosis of the disease. Methods: The levels of serum cortisol, ACTH and peripheral blood lymphocyte subsets were analyzed in 25 patients in the advanced-stage group with decreased blood pressure and 24 patients in the early-stage group with normal blood pressure. Twenty-five healthy children who underwent physical examination were selected as the control group. Children in the advanced-stage group were further divided into the death subgroup (n = 5) and the survival subgroup (n = 20).Results: At admission, the levels of serum cortisol and ACTH in the advanced-stage group were apparently higher than those in the early-stage group (P < 0.05). The advanced-stage group had significantly lower lymphocyte subset counts than the early-stage group (P < 0.05). On the 3rd day after admission, the levels of serum cortisol and ACTH in both groups decreased, and the counts of total lymphocytes, T cells and Th cells in the early-stage group were significantly higher than those at admission. On the 8th day after admission, there was no statistically significant difference in the levels of serum cortisol or ACTH between the groups. At admission, there was no statistically significant difference in serum cortisol and ACTH levels between the death subgroup and the survival subgroup. On the third day after admission, the levels of cortisol and ACTH were decreased in both groups, but the differences between the two subgroups were not statistically significant. All the lymphocyte subset counts in the death subgroup on the third day after admission were significantly lower than those in the survival subgroup (P < 0.05).Conclusions: The hypothalamic-pituitary-adrenal axis is excessively activated in children with SS. Higher serum cortisol and ACTH levels and lower peripheral blood lymphocyte subset counts indicate increased severity of the disease. After treatment, the first signs that indicate the effective control of the disease are decreased serum cortisol and ACTH levels and increased T cell, Th cell and total lymphocyte counts.