The purpose of the present study was to evaluate outcomes and identify prognostic factors in patients with acute leukemia who were admitted to the intensive care unit (ICU) with septic shock. Medical records of 50 patients with acute leukemia who were treated for septic shock in the Medical ICU of Samsung Medical Centre between September 2001 and June 2006 were retrospectively reviewed. The data were analysed for patient outcomes and for predictors of ICU mortality. ICU mortality and in-hospital mortality were 60% and 68%, respectively. The need for mechanical ventilation (p<0.001), the addition of norepinephrine to dopamine (p<0.001) and a poor Sequential Organ Failure Assessment (SOFA) score (p<0.001) were associated with ICU mortality in the univariate analysis. In the multivariate analysis using the Cox-model, a relapsed/refractory status for leukemia and poor SOFA score were independent predictors for ICU mortality. In conclusion, although the mortality was high in patients with acute leukemia who were admitted to the ICU for septic shock management, it was not high enough to preclude intensive care. Patients with severe organ failure and a relapse/refractory status for leukemia had a significantly worse prognosis.
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 µg/dL from the baseline after administration of 250 µg 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.
Because high levels of cortisol are frequently observed in patients with septic shock, low levels of serum cortisol are considered indicative of relative adrenal insufficiency (RAI). This study was performed to investigate whether pretest clinical characteristics, including basal serum cortisol levels, are predictive of serum cortisol response to corticotropin and whether basal cortisol levels have a prognostic significance in patients with septic shock. We performed a retrospective analysis of 68 patients with septic shock who underwent short corticotropin stimulation testing. RAI was defined as an increase in cortisol level <9 µg/dL from baseline, and results showed that 48 patients (70.6%) had this insufficiency. According to the univariate analysis, the RAI group had significantly higher simplified acute physiology score II (SAPS II) and sequential organ failure assessment (SOFA) scores than the non-RAI group. The incidence of RAI was the same regardless of the basal serum cortisol level (p=0.447). The hospital mortality rate was 58.8% and was not significantly different between the RAI and non-RAI groups. However, a high basal serum cortisol level (≥30 µg/dL) was significantly associated with in-hospital mortality. In conclusion, our data suggest that basal serum cortisol levels are not predictive of serum cortisol response to corticotropin but have a significant prognostic value in patients with septic shock.
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