A Prospective Study on the Incidence and Predictive Factors of Relative Adrenal Insufficiency in Korean Critically-Ill Patients

Kwon, Yong Soo; Kang, Eunhae; Suh, Gee Young; Koh, Won‐Jung; Chung, Man Pyo; Kim, Hojoong; Kwon, O Jung; Chung, Jae Hoon

doi:10.3346/jkms.2009.24.4.668

Cited by 10 publications

(13 citation statements)

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“…The rate of CIRCI in the present study was 58.5% (CIRCI was defined when Δ cortisol was less than 9 μg/dL), which was higher than another Korean study [17]. However, we failed to show a mortality difference between CIRCI and non-CIRCI.…”

Section: Discussioncontrasting

confidence: 84%

No Significance of the Free Cortisol Index Compared to Total Cortisol in Critically Ill Patients

Kim

et al. 2011

Endocrinol Metab

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Background: Some patients exhibit an inadequate response of cortisol to stressful conditions; this state is known as critical illnessrelated corticosteroid insufficiency. These patients have low serum binding protein concentrations, thereby suggesting that total serum cortisol may not be reflective of circulating cortisol activity. As the free cortisol index (FCI = total cortisol/corticosteroid-binding globulin) has been correlated with serum free cortisol, we measured FCI in Korean patients for the first time. In this study, we attempted to determine whether FCI was superior to total cortisol in predicting 30-day mortality. Methods: We recruited 65 critically ill patients with relatively high Acute Physiology, Age and Chronic Health Evaluation (APACHE III) scores. Fourteen patients with pituitary disease but normal pituitary function were recruited from outpatient clinics. Total cortisol and corticosteroid-binding globulin were measured in patients and controls during the short Synacthen test. Results: The basal cortisol level and basal FCI level were higher in patients (n = 65) than in healthy controls (P < 0.001, respectively). We found that total cortisol was strongly correlated with FCI (P < 0.001) in critically ill patients; however, neither total cortisol nor FCI were associated with 30-day mortality among patients. Only severe clinical criteria (such as APACHE-III scores and low albumin) were associated with 30-day mortality. Conclusion: Our results do not suggest that FCI is more accurate than total cortisol in predicting clinical outcomes in critically ill patients. (Endocrinol Metab 26:120-125, 2011)

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Section: Discussioncontrasting

confidence: 84%

No Significance of the Free Cortisol Index Compared to Total Cortisol in Critically Ill Patients

Kim

et al. 2011

Endocrinol Metab

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“…Previous studies have reported a CIRCI prevalence of 30%–70% in critically ill patients [3-5]. CIRCI in these patients is accompanied by elevated levels of inflammatory markers and coagulopathy and is associated with prolonged intensive care unit (ICU) stay and higher ICU mortality [2].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Implication of Adrenocortical Response during the Course of Critical Illness

et al. 2019

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BackgroundCritical illness-related corticosteroid insufficiency (CIRCI) and adrenocorticotropic hormone (ACTH)-cortisol dissociation are hormonal conditions frequently observed in patients in the intensive care unit (ICU). The aim of this study was to evaluate the association between ACTH-cortisol dissociation and clinical outcomes of critically ill patients. MethodsWe retrospectively reviewed the medical records of 94 ICU patients who underwent two rapid cosyntropin tests during hospital admission and compared the clinical aspects of patients with and without ACTH-cortisol dissociation. ACTH-cortisol dissociation was defined as plasma ACTH and serum cortisol concentrations of <22 pmol/L and >600 nmol/L, respectively. ResultsDissociation was present in 30 of the 94 patients (31.9%). Patients with ACTH-cortisol dissociation in the initial test had significantly higher hospital mortality rate than those in the control group (55% vs. 25.7%, P=0.013) There was no difference in hospital mortality between patients classified as having CIRCI and those who were not. In multivariate adjusted Cox regression analysis, the mortality risk was higher in the group with ACTH-cortisol dissociation (hazard ratio, 2.98; 95% confidence interval, 1.34 to 6.63; P=0.007). Patients with dissociation in two consecutive stimulation tests showed the highest hospital mortality rate among groups classified according to stimulation test results (100% vs. 31.3%). ConclusionsThe hospital mortality was higher in ICU patients diagnosed with ACTH-cortisol dissociation. It is clinically feasible to evaluate the presence of ACTH-cortisol dissociation by analyzing rapid ACTH stimulation test results in critically ill patients.

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“…In contrast, Soo Kwon et al . were able to demonstrate that people diagnosed to have RAI were more likely to have a higher SAPS II (Simplified Acute Physiology Score) and a SOFA (Sepsis Organ Failure Assessment) score . Soni et al .…”

Section: Relationship Between Cortisol Response To Corticotropin and mentioning

confidence: 97%

“…In contrast, Soo Kwon et al were able to demonstrate that people diagnosed to have RAI were more likely to have a higher SAPS II (Simplified Acute Physiology Score) and a SOFA (Sepsis Organ Failure Assessment) score. 42,53,54 Soni et al examined the association between adrenal responsiveness measured by the corticotropin test and cytokine levels and mortality. Interestingly, they observed that although mortality was higher in the group with adrenal insufficiency, there was no difference in cytokine concentrations between euadrenal and hypoadrenal states.…”

Section: Relationship Between Cortisol Response To Corticotropin and mentioning

confidence: 99%

The utility of the corticotropin test to diagnose adrenal insufficiency in critical illness: an update

Venkatesh

Cohen

2015

Clinical Endocrinology

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Objective One of the most common dynamic testing procedures for assessment of adrenocortical function is the standard corticotropin or the cosyntropin test. The aim of this review was to examine the evidence base underlying the corticotropin test in the management of the critically ill patient. Data synthesis The principle behind the corticotropin test is the demonstration of an inappropriately low cortisol production in response to exogenous ACTH, a situation analogous to physiological stress. The corticotropin test was originally described in nonstressed subjects, and its applicability and interpretation in the setting of critical illness continues to generate controversy. Attempting to determine the prevalence of an abnormal corticotropin test in critical illness is complicated by the use of different end-points and different populations. Moreover, the test result is also influenced by the assay used for measurement of plasma cortisol. Trials assessing the relationship between corticotropin response and severity of stress and organ dysfunction have produced divergent results, which may reflect differences in the methodology and the association being measured. Moreover, controversy exists with respect to the methodology and the interpretation with respect to the following variables: dose of corticotropin, end-points for assessment of total or free cortisol, effect of plasma cortisol variability, adrenal blood flow and its equivalence with other tests of adrenocortical function. Conclusions The corticotropin test is used widely in the evaluation of adrenocortical function in the endocrine clinics. Its role in the critically ill patient is less well established. Several confounding variables exist and to have a 'one-size-fits-all' approach with a single end-point in the face of several methodological and pathophysiological confounders may be flawed and may result in the institution of inappropriate therapy. The current evidence does not support the use of the corticotrophin test in critical illness to assess adrenocortical function and guiding steroid therapy in critical illness.

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A Prospective Study on the Incidence and Predictive Factors of Relative Adrenal Insufficiency in Korean Critically-Ill Patients

Cited by 10 publications

References 25 publications

No Significance of the Free Cortisol Index Compared to Total Cortisol in Critically Ill Patients

No Significance of the Free Cortisol Index Compared to Total Cortisol in Critically Ill Patients

Prognostic Implication of Adrenocortical Response during the Course of Critical Illness

The utility of the corticotropin test to diagnose adrenal insufficiency in critical illness: an update

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