J Med Assoc Thai 2018; 101 (11):1591-7

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Prevalence and Predictive Factors of Adrenal Insufficiency in Septic Shock Patients
Mingkuan W Mail, Debukkam S

Objective: To determine prevalence, risk factor and survival time associated with adrenal insufficiency [AI] in septic shock patients.

Materials and Methods: The prospective study was performed in all septic shock patients admitted within 24 hours with shock at the medical ward and medical intensive care unit between May 2016 and May 2017. Demographic data, clinical information, and cumulative survival time of patients were collected. Baseline cortisol was evaluated and followed by 1 microgram cosyntropin stimulation test. Serum cortisol was drawn at 30 and 60 minutes after injection, respectively. AI diagnosed by a level of cortisol increased less than 9 microgram/dl from baseline level or baseline cortisol less than 10 microgram/dl.

Results: One hundred twenty-two patients were recruited into the present study, and overall prevalence of AI was 56 (46%). Baseline serum cortisol between AI and no-AI groups were 17.7±7.7 microgram/dl versus 45.7±21.2 microgram/dl (p = 0.025). Predictive factors associated AI were herbal medicine used (OR 3.30, 95% CI 1.44 to 6.60, p = 0.002), serum CO2 less than18 mEq/L (OR 1.15, 95% CI 1.08 to 1.25, p = 0.038) and CHF (OR 11.80, 95% CI 1.14 to 121.80, p = 0.039). The median survival time between septic shock with baseline cortisol less than 25 microgram/dl versus more than 25 microgram/dl were 21 days and 12 days (p = 0.028).

Conclusion: AI is common in septic shock patients that have used herbal medicine, serum CO2 of less than 18 mEq/L, and CHF are useful risk factors during admission. In addition, the baseline cortisol level below 25 microgram/dl is associated with longer survival days.

Keywords: Prevalence, Risk factors, Adrenal insufficiency, Septic shock


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