Tuesday May 13, 2008
Adrenal insufficiency in prolonged critical illness

Interesting work from Taiwan !

Introduction: Adrenal insufficiency is frequently found in critically ill patients and affects their prognosis. But little is known about how the adrenal function changes during prolonged critical illness. This study was conducted to investigate the dynamic changes of 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. Acutely ill patients with initial cortisol level above 34mug/dL but without improvement after treatment, and who had follow-up cortisol levels during their critical illness, were studied. All clinical information and outcomes were recorded.

Results: 53 patients (with initial cortisol level above 34mug/dL) were included.

• 10 patients had follow-up cortisol levels remained more than 34mug/dL,
• 32 patients between 34 and 15mug/dL, and
• 15 patients less than 15mug/dL

Outcomes did not differ significantly among the three groups with different second cortisol levels.

In Cox regression analysis, patients who survived to hospital discharge with second cortisol levels less than 15mug/dL had a longer hospital length of stay (p = 0.004).

Conclusion: The majority of acutely ill patients who remained in critical condition had decreased serum cortisol levels. Lower follow-up cortisol levels might lead to worse clinical outcomes. Repeated testing for adrenal function is suggested for patients with prolonged critical illness.

Reference: click to get abstract

Adrenal insufficiency in prolonged critical illness: Critical Care 2008, 12:R65