{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T04:58:53Z","timestamp":1785560333317,"version":"3.56.0"},"reference-count":31,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Sepsis and septic shock remain leading causes of morbidity and mortality in intensive care units (ICUs) worldwide. While activation of the hypothalamic\u2013pituitary\u2013adrenal (HPA) axis is a vital adaptive response, the dissociation between cortisol and adrenal androgens like dehydroepiandrosterone (DHEA) is hypothesized to correlate with poor outcomes. This study aimed to evaluate the prognostic value of serum cortisol, DHEA, and the Cortisol\/DHEA ratio in patients with sepsis admitted to the ICU. Methods: Clinical and laboratory data from 106 adult sepsis patients in a tertiary care hospital were retrospectively analyzed. Disease severity was assessed using Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Glasgow Coma Scale (GCS) scores. Baseline cortisol and DHEA levels were measured at the time of diagnosis. Logistic regression and Cox proportional hazards models were employed to identify predictors of in-hospital mortality and time to death, respectively. Results: A total of 106 adult sepsis patients with a mean age of 73.63 \u00b1 13.70 years (55 female, 51.9%) were included in the study population. In the final logistic regression model, higher SOFA score was associated with greater odds of in-hospital mortality Odds ratio (OR) = 1.39 per 1-point increase, 95% Confidence interval (CI): 1.15\u20131.69, p &lt; 0.001). Higher platelet count (PLT) was associated with lower odds of mortality (OR = 0.958 per 10 \u00d7 109\/L increase, 95% CI: 0.919\u20130.998, p = 0.042), whereas higher urea was associated with greater odds of mortality (OR = 1.112 per 10 mg\/dL increase, 95% CI: 1.020\u20131.212, p = 0.016). The model area under the curve (AUC) was 0.7956. In univariable Cox analysis, higher baseline DHEA was associated with a greater hazard of death (Hazard ratio (HR) = 1.03, 95% CI: 1.014\u20131.046, p = 0.0002). In the final multivariable Cox proportional hazards model, baseline cortisol remained independently associated with the hazard of death (HR = 1.014, 95% CI: 1.007\u20131.022, p &lt; 0.001), whereas DHEA was not retained. Notably, the Cortisol\/DHEA ratio did not demonstrate independent prognostic value in either modeling approach. Conclusions: Higher baseline DHEA levels were associated with an increased hazard of death in univariable Cox proportional hazards analysis but did not retain independent prognostic significance in the final multivariable Cox proportional hazards model. While SOFA score remains the central prognostic tool, integrating continuous markers such as platelets and urea enhances risk stratification. The Cortisol\/DHEA ratio offers no incremental prognostic utility over established clinical parameters.<\/jats:p>","DOI":"10.3390\/jcm15155969","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:15:00Z","timestamp":1785428100000},"page":"5969","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of Serum Cortisol, DHEA, and SOFA Score in Adult Sepsis Patients: A Retrospective Single-Center Clinical Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9941-3109","authenticated-orcid":false,"given":"Pinar","family":"Ayvat","sequence":"first","affiliation":[{"name":"Anesthesiology and Reanimation Department, Faculty of Medicine, Izmir Democracy University, 35140 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9472-1340","authenticated-orcid":false,"given":"Nurbanu","family":"Sezak","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Clinical Microbiology Department, Faculty of Medicine, Izmir Democracy University, 35140 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcnal","family":"Bilek","sequence":"additional","affiliation":[{"name":"Business Management Department, Faculty of Economics and Administrative Sciences, Izmir Democracy University, 35140 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7249-0104","authenticated-orcid":false,"given":"Ali Galip","family":"Ayvat","sequence":"additional","affiliation":[{"name":"Project Management Department, Izmir Project Agency, 35210 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukaddes","family":"Colako\u011fullar\u0131","sequence":"additional","affiliation":[{"name":"Biochemistry Department, Faculty of Medicine, Izmir Democracy University, 35140 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcl\u015fah","family":"\u015eehito\u011flu Alpa\u011fut","sequence":"additional","affiliation":[{"name":"Emergency Medicine Department, Izmir Buca Seyfi Demirsoy Education and Training Hospital, 35390 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1830-8831","authenticated-orcid":false,"given":"\u015eeyda","family":"Kayhan \u00d6mero\u011flu","sequence":"additional","affiliation":[{"name":"Anesthesiology Department, Izmir Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, 35170 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2264-108X","authenticated-orcid":false,"given":"Hazal","family":"Koca","sequence":"additional","affiliation":[{"name":"Anesthesiology and Reanimation Department, Izmir Buca Seyfi Demirsoy Education and Training Hospital, 35390 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1001\/jama.283.8.1038","article-title":"A 3-Level Prognostic Classification in Septic Shock Based on Cortisol Levels and Cortisol Response to Corticotropin","volume":"283","author":"Annane","year":"2000","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1056\/NEJMoa020266","article-title":"Measurements of Serum Free Cortisol in Critically Ill Patients","volume":"350","author":"Hamrahian","year":"2004","journal-title":"N. 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