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Published:
Dec 21, 2006Keywords:
Adrenal insufficiency Cortisol Sepsis
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Adrenal insufficiency in critically ill septic patients at Dr George Mukhari Hospital
Abstract
Rationale: Adrenal insufficiency occurs with varying frequency in critically ill patients. It is usually associated with a high mortality and poor clinical outcome.
Objective: To determine the incidence of adrenal failure in patients with severe sepsis and septic shock admitted to our intensive care unit.
Design: Prospective observational study, over a two year period (June 2003 - June 2005).
Setting: University hospital multi-disciplinary intensive care unit in South Africa.
Patients: One hundred and fifty-two patients with severe sepsis and septic shock. Patients with a history of adrenal insufficiency, those on steroid therapy and all those who received etomidate within a week prior to enrollment were excluded.
Interventions: None.
Measurements and main results: A random plasma cortisol level was measured in consecutive patients with severe sepsis and septic shock. Adrenal insufficiency was defined as a cortisol level below 20µg/dL. The incidence of adrenal insufficiency was 26, 97% (CI: 19, 97% - 34, 03%). Patients with adrenal insufficiency had lower APACHE II scores and better short-term survival rates. The occurrence of adrenal dysfunction in patients with septic shock was low with an incidence of 15.6%. The type of infecting organism, site of infection and the origin of the sepsis were not associated with differences in the incidence of adrenal deficiency.
Conclusion: Absolute adrenal insufficiency is not uncommon among our critically septic patients. The presence of adrenal failure was inversely correlated with illness severity and mortality.
Southern African Journal of Anaesthesia and Analgesia Vol. 12(4) 2006: 135-138
Objective: To determine the incidence of adrenal failure in patients with severe sepsis and septic shock admitted to our intensive care unit.
Design: Prospective observational study, over a two year period (June 2003 - June 2005).
Setting: University hospital multi-disciplinary intensive care unit in South Africa.
Patients: One hundred and fifty-two patients with severe sepsis and septic shock. Patients with a history of adrenal insufficiency, those on steroid therapy and all those who received etomidate within a week prior to enrollment were excluded.
Interventions: None.
Measurements and main results: A random plasma cortisol level was measured in consecutive patients with severe sepsis and septic shock. Adrenal insufficiency was defined as a cortisol level below 20µg/dL. The incidence of adrenal insufficiency was 26, 97% (CI: 19, 97% - 34, 03%). Patients with adrenal insufficiency had lower APACHE II scores and better short-term survival rates. The occurrence of adrenal dysfunction in patients with septic shock was low with an incidence of 15.6%. The type of infecting organism, site of infection and the origin of the sepsis were not associated with differences in the incidence of adrenal deficiency.
Conclusion: Absolute adrenal insufficiency is not uncommon among our critically septic patients. The presence of adrenal failure was inversely correlated with illness severity and mortality.
Southern African Journal of Anaesthesia and Analgesia Vol. 12(4) 2006: 135-138
