A 3-Level Prognostic Classification in Septic Shock Based on Cortisol Levels and Cortisol Response to Corticotropin

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Abstract
Septic shock remains the most common cause of death in noncoronary intensive care units (ICUs).1 To tackle this problem, numerous anti-inflammatory therapies have been tested during the past decade, but all of them have been unable to improve survival in patients with severe sepsis.2 Thus, there is an urgent need to better characterize septic patients with the worst outcome. Several clinical prognostic factors have already been identified (ie, preexisting underlying disease, presence of organ dysfunction, and severity of illness scores).3 Moreover, the hormonal profile has been suggested to be a valid predictor of outcome in critically ill patients.4 However, a pathophysiologic derangement that could help identify a group of patients who might benefit from a particular treatment has not been characterized yet.