title: Incidence and outcomes of critical illness-related corticosteroid insufficiency in trauma patients.
abstract: The spectrum of critical illness-related corticosteroid insufficiency (CIRCI) in trauma is not fully defined. This study describes our trauma experience with hydrocortisone-treated patients experiencing CIRCI. We conducted a 5-year retrospective analysis from a Level II trauma center using biochemical and clinical criteria for adrenal insufficiency. Seventy patients met the inclusion criteria for CIRCI. There was a 34 per cent mortality rate despite therapy. Nonsurvivors were older with larger admission base deficits and experienced higher rates of sepsis, bacteremia, and pneumonia. Nonsurvivors had prolonged vent days (mean 53 ± 64 days) when compared with survivors (mean 30 ± 22 days; P = 0.029). Renal replacement therapy was a strong predictor of mortality. Spinal cord-injured patients had high Injury Severity Scores (mean 34 ± 18), elevated baseline cortisol levels (mean 56 ± 84 vs. 18 ± 14; P = 0.004), and required prolonged duration of steroid therapy (30 ± 52 vs. 15 ± 15 days; P = 0.080) when compared with the nonspinal cord-injured group. Our data suggest that CIRCI in trauma is associated with significant mortality and morbidity even when patients are treated appropriately.
authors.affiliation: Department of Surgery, Atlanta Medical Center and Surgical Health Collective, Atlanta, Georgia, USA. surghc1@aol.com
authors.forename: Mark L
authors.initials: ML
authors.lastname: Walker
authors.forename: Phillip S
authors.initials: PS
authors.lastname: Owen
authors.forename: Candace
authors.initials: C
authors.lastname: Sampson
authors.forename: Janene
authors.initials: J
authors.lastname: Marshall
authors.forename: Teresa
authors.initials: T
authors.lastname: Pounds
authors.forename: Vernon J
authors.initials: VJ
authors.lastname: Henderson
mesh_terms: D000305:Adrenal Cortex Hormones / Q000172:deficiency* / Q000378:metabolism*; D000309:Adrenal Insufficiency / Q000150:complications* / Q000188:drug therapy / Q000209:etiology*; D000328:Adult; D001774:Blood Chemical Analysis; D015331:Cohort Studies; D016638:Critical Illness / Q000453:epidemiology; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy
chemical_list: D000305:Adrenal Cortex Hormones