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Endocrine and Metabolic Responses in Children with Meningoccocal Sepsis: Striking Differences between Survivors and Nonsurvivors

The Department of Pediatrics, Division of Pediatric Intensive Care (K.F.M.J., E.D.d.K., M.W., M.d.H., F.C.v.E., E.v.V., J.A.H.), Division of Endocrinology (A.C.S.H.-K.), Sophia Children’s Hospital, and Department of Biostatistics and Epidemiology (W.C.J.H.), Erasmus University Rotterdam, 3000 CB Rotterdam, The Netherlands

Address correspondence and requests for reprints to: Koen F. M. Joosten, Ph.D., Department of Pediatrics, Division of Pediatric Intensive Care, Sophia Children’s Hospital, Erasmus University Rotterdam, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. E-mail: joosten{at}alkg.azr.nl

To get insight in the endocrine and metabolic responses in children with meningococcal sepsis 26 children were studied the first 48 h after admission. On admission there was a significant difference in cortisol/ACTH levels between nonsurvivors (n = 8) and survivors (n = 18). Nonsurvivors showed an inadequate cortisol stress response in combination to very high ACTH levels, whereas survivors showed a normal stress response with significantly higher cortisol levels (0.62 vs. 0.89 µmol/L) in combination with moderately increased ACTH levels (1234 vs. 231 ng/L). Furthermore, there was a significant difference between nonsurvivors and survivors regarding pediatric risk of mortality score (31 vs. 17), TSH (0.97 vs. 0.29 mE/L), T₃ (0.53 vs. 0.38 nmol/L), reverse T₃ (rT₃) (0.75 vs. 1.44 nmol/L), C-reactive protein (34 vs. 78 mg/L), nonesterified fatty acids (0.32 vs. 0.95 mmol/L), and lactate (7.3 vs. 3.2 mmol/L). In those who survived, the most important changes within 48 h were seen in a normalization of cortisol and ACTH levels, but without a circadian rhythm; a decrease of rT₃ and an increase in the T₃/rT₃ ratio; and a decrease in the levels of the nonesterified free fatty acids and an unaltered high urinary nitrogen excretion. At this moment, it is yet unknown whether the hormonal abnormalities are determining factors in the outcome of acute meningococcal sepsis or merely represent secondary effects. Understanding the metabolic and endocrine alterations is required to design possible therapeutic approaches. The striking difference between nonsurvivors and survivors calls for reconsideration of corticosteroid treatment in children with meningococcal sepsis.

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