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Adrenal insufficiency in prolonged critical illness
Jenn-Yu Wu1, Szu-Chun Hsu, Shih-Chi Ku
1Department of Internal Medicine, National Taiwan University Hospital, Chung-Shan South Road, Taipei, Taiwan 100, Republic of China.
Critical Care (London, England)
|May 10, 2008
Summary
Critically ill patients often experience declining cortisol levels. Monitoring adrenal function with repeated testing may improve outcomes in prolonged critical illness.
Area of Science:
- Endocrinology
- Critical Care Medicine
Background:
- Adrenal insufficiency is prevalent in critically ill patients, impacting prognosis.
- Dynamic changes in adrenal function during prolonged critical illness remain poorly understood.
Purpose of the Study:
- To investigate dynamic changes in serum cortisol levels in critically ill patients who do not improve with initial treatment.
- To assess the relationship between follow-up cortisol levels and clinical outcomes.
Main Methods:
- Observational cohort study conducted in intensive care units.
- Included acutely ill patients with initial high cortisol levels (>34 microg/dl) who lacked improvement.
- Follow-up cortisol levels were determined during ongoing critical illness.
Main Results:
- Majority of patients (47/57) showed decreased serum cortisol levels at follow-up.
- No significant difference in outcomes based on follow-up cortisol level groups.
- Lower follow-up cortisol levels (<15 microg/dl) were associated with longer hospital stay in survivors (OR=14.8, P=0.004).
Conclusions:
- Most critically ill patients with persistent critical condition exhibit reduced serum cortisol.
- Depressed follow-up cortisol levels may correlate with adverse clinical outcomes.
- Repeated adrenal function testing is recommended for patients with prolonged critical illness.
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