title: Prognostic significance of different subgroup classifications of critical illness-related corticosteroid insufficiency in patients with septic shock.
abstract: The purpose of this study was to evaluate the prognostic significance of classification of patients with septic shock into different critical illness-related corticosteroid insufficiency subgroups. A retrospective observational study was conducted in patients with septic shock who underwent a short corticotropin stimulation test within 72 h of the onset of shock. Patients were classified into normal adrenal function (NOM), low basal cortisol (LBC) (basal cortisol, <10 μg/dL), or low Δ cortisol (LDC) (basal cortisol, ≥10 μg/dL; cortisol, <9 μg/dL) groups. A total of 168 septic shock patients were recruited. Forty-two patients (25%) were assigned to the NOM group, 39 (23.2%) to the LBC group, and 87 (51.8%) to the LDC group. All of the patients received hydrocortisone therapy. Patients in the LDC group had significantly higher Simplified Acute Physiology Score 3 (P < 0.001) and Sequential Organ Failure Assessment score (P < 0.001) than did patients in the NOM group. The 28-day mortalities of the NOM, LBC, and LDC groups were 40.5%, 38.5%, and 63.2%, respectively (P = 0.007). Classification into the LDC group significantly increased the odds of 28-day mortality (odds ratio, 2.717; 95% confidence interval, 1.452-5.082; P = 0.002) and remained an independent risk factor for mortality even after controlling for all the other potential risk factors identified (odds ratio, 3.638; 95% confidence interval, 1.418-9.028; P = 0.006). Classification into the LDC group is an independent risk factor for mortality in hydrocortisone-treated septic shock patients.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Lim
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Kwon
authors.forename: Maeng Real
authors.initials: MR
authors.lastname: Park
authors.forename: Seo Goo
authors.initials: SG
authors.lastname: Han
authors.forename: Kyeongman
authors.initials: K
authors.lastname: Jeon
authors.forename: Sang-Won
authors.initials: SW
authors.lastname: Um
authors.forename: Won-Jung
authors.initials: WJ
authors.lastname: Koh
authors.forename: Man Pyo
authors.initials: MP
authors.lastname: Chung
authors.forename: Hojoong
authors.initials: H
authors.lastname: Kim
authors.forename: O Jung
authors.initials: OJ
authors.lastname: Kwon
authors.forename: Gee Young
authors.initials: GY
authors.lastname: Suh
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood* / Q000378:metabolism / Q000401:mortality; D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000368:Aged; D016001:Confidence Intervals; D016638:Critical Illness; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007723:Korea; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012772:Shock, Septic / Q000097:blood* / Q000378:metabolism / Q000401:mortality
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone