Avaliação do cortisol salivar no paciente em estado crítico

Abstract

Critical care patient presents important alterations in synthesis and release of cortisol, with great elevation of its serum levels, proportional to the severity of the case. Some patients, other way, presents adrenal response that is inadequate for the stress which the organism is passing through, with elevated serum cortisol, but in an insufficient level to make benefit to the homeostasis. This state is named relative adrenal insufficiency. These patients present more severe disease, and higher mortality. To date, adrenal evaluation in critical care patients is based on serum levels of total cortisol, including, free fraction plus protein-bonded fraction. Adrenal evaluation by serum free cortisol seems to be more reliable, reflecting active fraction of hormone. Salivary cortisol represents an excellent index of serum free cortisol. The objective of the study was to evaluate values of total serum and salivary cortisol in critical care patients, evaluating correlation among values, and the correlation with patient prognosis. Sixty six patients were divided in 3 groups: twenty seven patients with severe sepsis, from intensive care unit, twenty post-operatory stable patients in intensive care unit, and nineteen healthy controls. We found a strong serum and salivary cortisol correlation, with Pearson r value of 0,89, and serum total and salivary cortisol elevated levels were associated with higher mortality. Salivary cortisol levels presented more significant elevations compared with basal levels, because they are not bond to protein, and were better associated with mortality.