title: A prospective study on the incidence and predictive factors of relative adrenal insufficiency in Korean critically-ill patients.
abstract: This study was undertaken to evaluate the incidence and risk factors associated with relative adrenal insufficiency (RAI) in Korean critically-ill patients. All patients who were admitted to the Medical Intensive Care Unit (MICU) of Samsung Medical Center between January 1, 2006 and April 30, 2007 were prospectively evaluated using a short corticotropin stimulation test on the day of admission. RAI was defined as an increase in the serum cortisol level of <9 microg/dL from the baseline after administration of 250 microg of corticotropin. In all, 123 patients were recruited and overall the incidence of RAI was 44% (54/123). The presence of septic shock (P=0.001), the Simplified Acute Physiology Score (SAPS) II (P=0.003), the Sequential Organ Failure Assessment (SOFA) score (P=0.001), the mean heart rate (P=0.040), lactate levels (P=0.001), arterial pH (P=0.047), treatment with vasopressors at ICU admission (P=0.004), and the 28-day mortality (P=0.041) were significantly different between patients with and without RAI. The multivariate analysis showed that the SOFA score was an independent predictor of RAI in critically-ill patients (odd ratio=1.235, P=0.032). Our data suggest that RAI is frequently found in Korean critically-ill patients and that a high SOFA score is an independent predictor of RAI in these patients.
authors: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Yong Soo
authors: YS
authors: Kwon
authors: Eunhae
authors: E
authors: Kang
authors: Gee Young
authors: GY
authors: Suh
authors: Won-Jung
authors: WJ
authors: Koh
authors: Man Pyo
authors: MP
authors: Chung
authors: Hojoong
authors: H
authors: Kim
authors: O Jung
authors: OJ
authors: Kwon
authors: Jae Hoon
authors: JH
authors: Chung
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007362:Intensive Care Units; D007723:Korea; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone