Korean J Thorac Cardiovasc Surg.  2018 Apr;51(2):109-113. 10.5090/kjtcs.2018.51.2.109.

Critical Illness-Related Corticosteroid Insufficiency in Patients with Low Cardiac Output Syndrome after Cardiac Surgery

• Ok YJ
• Lim JY
• Jung SH

• KMID: 2409694
• DOI: http://doi.org/10.5090/kjtcs.2018.51.2.109

Abstract

BACKGROUND
Low cardiac output syndrome (LCOS) after cardiac surgery usually requires inotropes. In this setting, critical illness-related corticosteroid insufficiency (CIRCI) may develop. We aimed to investigate the clinical features of CIRCI in the presence of LCOS and to assess the efficacy of steroid treatment.
METHODS
We reviewed 28 patients who underwent a rapid adrenocorticotropic hormone (ACTH) test due to the suspicion of CIRCI between February 2010 and September 2014. CIRCI was diagnosed by a change in serum cortisol of <9 μg/dL after the ACTH test or a random cortisol level of <10 μg/dL.
RESULTS
Twenty of the 28 patients met the diagnostic criteria. The patients with CIRCI showed higher Sequential Organ Failure Assessment (SOFA) scores than those without CIRCI (16.1±2.3 vs. 11.4±3.5, p=0.001). Six of the patients with CIRCI (30%) received glucocorticoids. With an average elevation of the mean blood pressure by 22.2±8.7 mm Hg after steroid therapy, the duration of inotropic support was shorter in the steroid group than in the non-steroid group (14.1±2.3 days versus 30±22.8 days, p=0.001). Three infections (15%) developed in the non-steroid group, but this was not a significant between-group difference.
CONCLUSION
CIRCI should be suspected in patients with LCOS after cardiac surgery, especially in patients with a high SOFA score. Glucocorticoid replacement therapy may be considered to reduce the use of inotropes without posing an additional risk of infection.

Keyword

Critical illness; Adrenal insufficiency; Low cardiac output syndrome; Corticosteroids; Wound infection

MeSH Terms

Adrenal Cortex Hormones
Adrenal Insufficiency
Adrenocorticotropic Hormone
Blood Pressure
Cardiac Output, Low*
Critical Illness
Glucocorticoids
Humans
Hydrocortisone
Thoracic Surgery
Wound Infection
Adrenal Cortex Hormones
Adrenocorticotropic Hormone
Glucocorticoids
Hydrocortisone