Serum Cortisol, Lactate Levels and Correlation with Outcome in Pediatric Shock

Serum cortisol levels rise in response to stress of critical illness but the optimum range of serum cortisol in such settings is not clearly defined. An association of high lactate levels with mortality has been found in adult patients with septic shock. However there is controversial literature regarding the same in children. The aim of this study was to determine the serum cortisol level and lactate level in Pediatric circulatory shock and to correlate their level with mortality. This was a prospective observational study at PICU of tertiary care centre at Indira Gandhi Institute of Child Health. A Total of 50 children admitted to PICU with diagnosis of shock were included in the study. Clinical and demographic characteristics of study patients were recorded. Serum cortisol and lactate levels were measured at 0 and 6 hrs of diagnosis of shock along with other relevant laboratory investigations. The outcome (survival or death) was correlated with cortisol and lactate levels. High mortality was observed in patients with low cortisol level <7mcg/dl and also in patients with high cortisol levels of >46mcg/dl. High mortality was also observed in patients with very high lactate levels. Initial as well as subsequent lactate levels were high in majority of non-survivors. Low cortisol level of <7mcg/dl , high cortisol level >46mcg/dl and very high Lactate levels of >45 mg/dl in circulatory shock is associated with higher mortality and are poor prognostic factors independently.