A Prospective Study on the Incidence and Predictive Factors of Relative Adrenal Insufficiency in Korean Critically-Ill Patients.
10.3346/jkms.2009.24.4.668
- Author:
Yong Soo KWON
1
;
Eunhae KANG
;
Gee Young SUH
;
Won Jung KOH
;
Man Pyo CHUNG
;
Hojoong KIM
;
O Jung KWON
;
Jae Hoon CHUNG
Author Information
1. Divisions of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. suhgy@skku.edu
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Adrenal Insufficiency;
SOFA Score;
Critical Illness
- MeSH:
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
- From:Journal of Korean Medical Science
2009;24(4):668-673
- CountryRepublic of Korea
- Language:English
-
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.
