Adrenal insufficiency in prolonged critical illness

Jenn-Yu Wu , Szu-Chun Hsu , Shih-Chi Ku , Chao-Chi Ho , Chong-Jen Yu and Pan-Chyr Yang

Critical Care 2008, 12:R65doi:10.1186/cc6895


Published:	8 May 2008

Abstract (provisional)

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

Fifty-three patients were included. Ten patients had follow-up cortisol levels > 34mug/dL, 32 patients between 34 and 15mug/dL, and 15 patients < 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 < 15mug/dL had a longer hospital length of stay (p = 0.004, odds ratio 14.8, 95% confidence ratio 2.4 to 90.0).

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.