Adrenal insufficiency in prolonged critical illness.
BACKGROUND
Adrenal insufficiency is common in critically ill patients and affects their prognosis, but little is known about how adrenal function changes during prolonged critical illness. This study was conducted to investigate dynamic changes in 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. We studied acutely ill patients with initial cortisol level above 34 microg/dl, but who did not improve after treatment and in whom follow-up cortisol levels were determined during critical illness. All clinical information and outcomes were recorded.


RESULTS
Fifty-seven patients were included. Ten patients had follow-up cortisol levels above 34 microg/dl, 32 patients had levels between 34 and 15 microg/dl, and 15 patients had levels under 15 microg/dl. Outcomes did not differ significantly among the three groups with different follow-up cortisol levels. In Cox regression analysis, those patients who survived to hospital discharge with second cortisol levels under 15 microg/dl had a longer hospital length of stay (odds ratio = 14.8, 95% confidence interval = 2.4 to 90.0; P = 0.004).


CONCLUSIONS
The majority of acutely ill patients who remained in a critical condition had decreased serum cortisol levels. Depressed cortisol levels at follow up may lead to worse clinical outcomes. We propose that repeated adrenal function testing be conducted in patients with prolonged critical illness.
Wu
Jenn-Yu
JY
Department of Internal Medicine, National Taiwan University Hospital, Chung-Shan South Road, Taipei, Taiwan 100, Republic of China.
Hsu
Szu-Chun
SC
Ku
Shih-Chi
SC
Ho
Chao-Chi
CC
Yu
Chong-Jen
CJ
Yang
Pan-Chyr
PC
D000309:Adrenal Insufficiency / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000627:therapeutic use; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012121:Respiration, Artificial
D006854:Hydrocortisone