Critical illness-related corticosteroid insufficiency in patients with severe acute biliary pancreatitis: a prospective cohort study.
BACKGROUND
Gallstones are the most common cause of acute pancreatitis worldwide. Patients with severe acute biliary pancreatitis (SABP) constitute a subgroup of severe acute pancreatitis (SAP) patients in whom systemic inflammation may be triggered and perpetuated by different mechanisms. The aim of this prospective investigation was to examine the adrenal response to corticotropin and the relationship between adrenal function and outcome in patients with SABP.


METHODS
Thirty-two patients with SABP were enrolled in this study. A short corticotropin (250 microg) stimulation test (SST) was performed within the first 24 hours of admission to the ICU. Critical illness related corticosteroid insufficiency (CIRCI) was defined as follows: baseline value less than 10 microg/dL, or cortisol response less than 9 microg/dL.


RESULTS
CIRCI occurred in 34.4% of patients. The patients with CIRCI were more severely ill as evidenced by higher APACHE II and SOFA scores and numbers of organ system dysfunction on the day of SST. The in-hospital mortality for the entire group was 21.9%. The CIRCI group had a higher hospital mortality rate compared to those with normal adrenal function (45.5% vs. 9.5%, P = 0.032). The hospital survivors had a higher cortisol response to corticotropin (17.4 (8.3-27.1) vs. 7.2 (1.7-12) microg/dL, P = 0.019). The cortisol response to corticotropin inversely correlated with SOFA score and the number of organ dysfunction on the day of SST. The rates of pancreatic necrosis and bacteremia were significantly higher in the CIRCI group (100% vs 42.9%, P = 0.002; 81.8% vs 23.8%, P = 0.003, respectively).


CONCLUSIONS
CIRCI is common in patients with SABP. It is associated with bacteremia, multiple organ dysfunction and increased mortality.
Peng
Yun-Shing
YS
Division of Endocrinology, Chang Gung Memorial Hospital, 6, West Section, Chia-Pu Road, Chia-Yi 613, Taiwan. pengys@cgmh.org.tw
Wu
Cheng-Shyong
CS
Chen
Yung-Chang
YC
Lien
Jau-Min
JM
Tian
Ya-Chung
YC
Fang
Ji-Tseng
JT
Yang
Chun
C
Chu
Yun-Yi
YY
Hung
Chien-Fu
CF
Yang
Chih-Wei
CW
Chen
Pang-Chi
PC
Tsai
Ming-Hung
MH
D018806:APACHE; D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000172:deficiency*; D000368:Aged; D001660:Biliary Tract Diseases / Q000150:complications / Q000503:physiopathology*; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000503:physiopathology*
D000305:Adrenal Cortex Hormones