The Effect of Serum Adiponectin and Cortisol Levels on Prognosis in the Patients with Sepsis and Septic Shock

Abstract

Objectives: Severe sepsis and septic shock are among the most important causes of death in the intensive care units. Sepsis is a severe stress condition. Hypothalamic-pituitary-adrenal axis plays an important role in response to stress. The increase in cortisol level is important in maintaining vascular reactivity, regulating the immune response, and ensuring the balance of the body during acute disease. Adiponectin is an adipocytokine released from adipose tissue, which is now thought to play a role in the pathogenesis of diseases such as diabetes mellitus, atherosclerosis, malignancy, and sepsis, with its anti-inflammatory, insulin-sensitizing, and anti-atherosclerotic effects. The aim of this study is to investigate the relationship of cortisol and anti-inflammatory adiponectin, which are effective in the stress response of the body, with metabolic parameters, inflammation, and prognosis in the patients diagnosed with sepsis. Methods: Twenty-nine patients who were admitted to Gazi University, Faculty of Medicine Internal Diseases Intensive Care Unit with the diagnoses of severe sepsis and septic shock, 23 patients who were admitted to the unit for a reason other than sepsis, and 22 healthy outpatients of similar age were included in the study. Blood samples of the patients were collected, and their demographic data were recorded during their admission to the intensive care unit. Results: Although not statistically significant, serum adiponectin level was higher in the septic shock group compared to the other two groups (p=0.217). Serum adiponectin levels observed after recovering from sepsis were found to be significantly increased compared to the levels at the time of diagnosis (p<0.001). Serum adiponectin levels were found to have no significant effect on mortality (p=0.423). Serum cortisol levels were statistically significantly higher in the patients with sepsis compared to those without sepsis (p=0.0001). In addition, a positive correlation was found between serum adiponectin level and cortisol (r=0.49, p=0.013). There was also a negative correlation between serum adiponectin level and C-reactive protein level (r=-0.331, p=0.019). Conclusion: Our findings suggest that adiponectin plays a role in sepsis as a part of the inflammatory and metabolic response. Prospective studies examining more cases are needed to use adiponectin as a prognostic marker in the patients with sepsis.