Critical Illness-Related Corticosteroid Insufficiency in Patients with Low Cardiac Output Syndrome after Cardiac Surgery.
10.5090/kjtcs.2018.51.2.109
- Author:
You Jung OK
1
;
Ju Yong LIM
;
Sung Ho JUNG
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea. csjung@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Critical illness;
Adrenal insufficiency;
Low cardiac output syndrome;
Corticosteroids;
Wound infection
- MeSH:
Adrenal Cortex Hormones;
Adrenal Insufficiency;
Adrenocorticotropic Hormone;
Blood Pressure;
Cardiac Output, Low*;
Critical Illness;
Glucocorticoids;
Humans;
Hydrocortisone;
Thoracic Surgery;
Wound Infection
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2018;51(2):109-113
- CountryRepublic of Korea
- Language:English
-
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.
