J Korean Med Sci.  2009 Aug;24(4):668-673. 10.3346/jkms.2009.24.4.668.

A Prospective Study on the Incidence and Predictive Factors of Relative Adrenal Insufficiency in Korean Critically-Ill Patients

• Kwon YS
• Kang E
• Suh GY
• Koh WJ
• Chung MP
• Kim H
• Kwon OJ
• Chung JH

• KMID: 1779201
• DOI: http://doi.org/10.3346/jkms.2009.24.4.668

Abstract

This study was undertaken to evaluate the incidence and risk factors associated with relative adrenal insufficiency (RAI) in Korean critically-ill patients. All patients who were admitted to the Medical Intensive Care Unit (MICU) of Samsung Medical Center between January 1, 2006 and April 30, 2007 were prospectively evaluated using a short corticotropin stimulation test on the day of admission. RAI was defined as an increase in the serum cortisol level of <9 microgram/dL from the baseline after administration of 250 microg of corticotropin. In all, 123 patients were recruited and overall the incidence of RAI was 44% (54/123). The presence of septic shock (P=0.001), the Simplified Acute Physiology Score (SAPS) II (P=0.003), the Sequential Organ Failure Assessment (SOFA) score (P=0.001), the mean heart rate (P=0.040), lactate levels (P=0.001), arterial pH (P=0.047), treatment with vasopressors at ICU admission (P=0.004), and the 28-day mortality (P=0.041) were significantly different between patients with and without RAI. The multivariate analysis showed that the SOFA score was an independent predictor of RAI in critically-ill patients (odd ratio=1.235, P=0.032). Our data suggest that RAI is frequently found in Korean critically-ill patients and that a high SOFA score is an independent predictor of RAI in these patients.

Keyword

Adrenal Insufficiency; SOFA Score; Critical Illness

MeSH Terms

Adrenal Insufficiency/diagnosis/*epidemiology/mortality
Adrenocorticotropic Hormone/diagnostic use
Adult
Aged
*Critical Illness
Female
Humans
Hydrocortisone/blood
Intensive Care Units
Korea
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Prospective Studies
ROC Curve
Risk Factors
Severity of Illness Index
Survival Rate

Figure

• 

  Fig. 1 Receiver operator curve (ROC) analysis of Sepsis-Related Organ Failure scores predicting adrenal insufficiency in critically-ill patients. AUC, area under the ROC curve.

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