Salivary Cortisol Can Replace Free Serum Cortisol Measurements in Patients with Septic Shock.
Chest. 2011 Aug 4;
Authors: Estrada-Y-Martin RM, Orlander PR
Abstract BACKGROUND: There is a renewed interest in adrenal function during severe sepsis. Most studies have used total serum cortisol. However, only free serum cortisol is biologically active. The aim was to determine the validity of salivary cortisol as surrogate for free serum cortisol during septic shock. METHODS: Fifty-seven patients with septic shock were study to determine the correlation between total serum cortisol and salivary cortisol to free serum cortisol. Thirty-eight patients were included in the salivary to free serum cortisol correlation. Salivary cortisol was tested by EIA. Serum total cortisol, free cortisol and cortisol binding globulin were determined by LC-MS liquid chromatography, equilibrium analysis and radioimmunoassay, respectively. RESULTS: The mean ± SD age was 56.6 ± 18.5. Fifty-seven percent were female. APACHE II score median was 26, SAPS II median 61 and SOFA median 13. The correlation between salivary and free serum cortisol was 0.79, (95% CI 0.63 - 0.89) p < 0.0001. The correlation between free serum cortisol and total serum cortisol was 0.86 (95% CI 0.78 - 0.92) p < 0.0001. The mean ± SD free serum cortisol was 2.27?g/dL ± 1.64. The mean ± SD salivary cortisol was 2.60?g/dL ± 2.69. The mean ± SD total serum cortisol was 21.56?g/dL ± 8.71. The mean ± SD cortisol binding globulin was 23.54 mg/dL ± 8.33 mg/dL. CONCLUSIONS: Salivary cortisol can be used as a surrogate of free serum cortisol in patients with septic shock with very good correlation. Salivary cortisol is non-invasive, easy to perform and can be conducted daily.
PMID: 21816912 [PubMed - as supplied by publisher]