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Adrenal insufficiency in prolonged critical illness.

Wu JY, Hsu SC, Ku SC, Ho CC, Yu CJ, Yang PC - Crit Care (2008)

Bottom Line: All clinical information and outcomes were recorded.Fifty-seven patients were included.The majority of acutely ill patients who remained in a critical condition had decreased serum cortisol levels.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, National Taiwan University Hospital, Chung-Shan South Road, Taipei, Taiwan 100, Republic of China.

ABSTRACT

Introduction: Adrenal insufficiency is common in critically ill patients and affects their prognosis, but little is known about how adrenal function changes during prolonged critical illness. This study was conducted to investigate dynamic changes in cortisol levels in patients with critical illness who do not improve after treatment.

Methods: This observational cohort study was performed in the intensive care units of a university hospital. We studied acutely ill patients with initial cortisol level above 34 microg/dl, but who did not improve after treatment and in whom follow-up cortisol levels were determined during critical illness. All clinical information and outcomes were recorded.

Results: Fifty-seven patients were included. Ten patients had follow-up cortisol levels above 34 microg/dl, 32 patients had levels between 34 and 15 microg/dl, and 15 patients had levels under 15 microg/dl. Outcomes did not differ significantly among the three groups with different follow-up cortisol levels. In Cox regression analysis, those patients who survived to hospital discharge with second cortisol levels under 15 microg/dl had a longer hospital length of stay (odds ratio = 14.8, 95% confidence interval = 2.4 to 90.0; P = 0.004).

Conclusion: The majority of acutely ill patients who remained in a critical condition had decreased serum cortisol levels. Depressed cortisol levels at follow up may lead to worse clinical outcomes. We propose that repeated adrenal function testing be conducted in patients with prolonged critical illness.

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Related in: MedlinePlus

Flow chart of patient recruitment. ICU, intensive care unit; SOFA, Sequential Organ Failure Assessment.
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Figure 1: Flow chart of patient recruitment. ICU, intensive care unit; SOFA, Sequential Organ Failure Assessment.

Mentions: In this cohort study, 12,908 sets of cortisol data from 6,926 patients were analyzed (Figure 1). From 109 patients who satisfied the inclusion criteria, 52 exhibited clinical improvement (decrease in SOFA score) and were excluded. Fifty-seven patients remained for analysis. Their primary reasons for ICU admission were pneumonia (40.4%), sepsis (26.3%), acute myocardial infarction (8.8%), chronic obstructive pulmonary disease (5.3%), congestive heart failure (5.3%), arrhythmia (5.3%), hypovolemic shock (5.3%), and cerebrovascular accident (3.5%). The median age was 79 years, and 33 of the 57 patients were male.


Adrenal insufficiency in prolonged critical illness.

Wu JY, Hsu SC, Ku SC, Ho CC, Yu CJ, Yang PC - Crit Care (2008)

Flow chart of patient recruitment. ICU, intensive care unit; SOFA, Sequential Organ Failure Assessment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2481448&req=5

Figure 1: Flow chart of patient recruitment. ICU, intensive care unit; SOFA, Sequential Organ Failure Assessment.
Mentions: In this cohort study, 12,908 sets of cortisol data from 6,926 patients were analyzed (Figure 1). From 109 patients who satisfied the inclusion criteria, 52 exhibited clinical improvement (decrease in SOFA score) and were excluded. Fifty-seven patients remained for analysis. Their primary reasons for ICU admission were pneumonia (40.4%), sepsis (26.3%), acute myocardial infarction (8.8%), chronic obstructive pulmonary disease (5.3%), congestive heart failure (5.3%), arrhythmia (5.3%), hypovolemic shock (5.3%), and cerebrovascular accident (3.5%). The median age was 79 years, and 33 of the 57 patients were male.

Bottom Line: All clinical information and outcomes were recorded.Fifty-seven patients were included.The majority of acutely ill patients who remained in a critical condition had decreased serum cortisol levels.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, National Taiwan University Hospital, Chung-Shan South Road, Taipei, Taiwan 100, Republic of China.

ABSTRACT

Introduction: Adrenal insufficiency is common in critically ill patients and affects their prognosis, but little is known about how adrenal function changes during prolonged critical illness. This study was conducted to investigate dynamic changes in cortisol levels in patients with critical illness who do not improve after treatment.

Methods: This observational cohort study was performed in the intensive care units of a university hospital. We studied acutely ill patients with initial cortisol level above 34 microg/dl, but who did not improve after treatment and in whom follow-up cortisol levels were determined during critical illness. All clinical information and outcomes were recorded.

Results: Fifty-seven patients were included. Ten patients had follow-up cortisol levels above 34 microg/dl, 32 patients had levels between 34 and 15 microg/dl, and 15 patients had levels under 15 microg/dl. Outcomes did not differ significantly among the three groups with different follow-up cortisol levels. In Cox regression analysis, those patients who survived to hospital discharge with second cortisol levels under 15 microg/dl had a longer hospital length of stay (odds ratio = 14.8, 95% confidence interval = 2.4 to 90.0; P = 0.004).

Conclusion: The majority of acutely ill patients who remained in a critical condition had decreased serum cortisol levels. Depressed cortisol levels at follow up may lead to worse clinical outcomes. We propose that repeated adrenal function testing be conducted in patients with prolonged critical illness.

Show MeSH
Related in: MedlinePlus