title: Prognostic value of relative adrenal insufficiency after out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  To assess the prevalence of relative adrenal insufficiency in patients successfully resuscitated after cardiac arrest, and its prognostic role in post-resuscitation disease.
  
  
  METHODS
  A prospective observational single-center study in a medical intensive care unit.
  
  
  METHODS
  64 patients hospitalised in the intensive care unit after successful resuscitation for out-of-hospital cardiac arrest.
  
  
  RESULTS
  A corticotropin-stimulation test was performed between 12 and 24 h following admission: serum cortisol level was measured before and 60 min after administration of tetracosactide 250 microg. Patients with an incremental response less than 9 microg/dl were considered to have relative adrenal insufficiency (non-responders). Variables were expressed as medians and interquartile ranges. 33 patients (52%) had relative adrenal insufficiency. Baseline cortisol level was higher in non-responders than in responders (41 [27.2-55.5] vs. 22.8 [15.7-35.1] microg/dl respectively, P=0.001). A long interval before initiation of cardiopulmonary resuscitation was associated with relative adrenal insufficiency (5 [3-10] vs. 3 [3-5] min, P=0.03). Of the 38 patients with post-resuscitation shock, 13 died of irreversible multiorgan failure. The presence of relative adrenal insufficiency was identified as a poor prognostic factor of shock-related mortality (log-rank P=0.02). A trend towards higher mortality in non-responders was identified in a multivariate logistic regression analysis (odds ratio 6.77, CI 95% 0.94-48.99, P=0.058).
  
  
  CONCLUSIONS
  Relative adrenal insufficiency occurs frequently after successful resuscitation of out-of-hospital cardiac arrest, and appears to be associated with a poor prognosis in cases of post-resuscitation shock. The role of corticosteroid supplementation should be evaluated in this setting.
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France. frederic.penne@cch.ap-hop-paris.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pene
authors.forename: Hervé
authors.initials: H
authors.lastname: Hyvernat
authors.forename: Vincent
authors.initials: V
authors.lastname: Mallet
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.forename: Pierre
authors.initials: P
authors.lastname: Carli
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Marie-Annick
authors.initials: MA
authors.lastname: Dugue
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
mesh_terms: D000309:Adrenal Insufficiency / Q000453:epidemiology* / Q000209:etiology; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D005260:Female; D005602:France / Q000453:epidemiology; D006323:Heart Arrest / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019370:Observation; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology