Critical Illness-Related Corticosteroid Insufficiency (CIRCI) among Patients with COVID-19 at a Tertiary Hospital: Clinical Characteristics and Outcomes

Arcellana, Anna Elvira; Lim, Kenneth Wilson; Arcegono, Marlon; Jimeno, Cecilia

doi:10.15605/jafes.038.01.02

Cited by 2 publications

(2 citation statements)

References 34 publications

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“…In a prospective trial by Bagate et al ( 27 ), only patients who initially failed to meet criteria for extubation were enrolled, and among them, CIRCI occurred in 33% and was associated with a higher likelihood of subsequent extubation failure. In a retrospective study by Arcellana et al ( 32 ), COVID-19 diagnosed with probable or definite CIRCI had longer median days on a ventilator; however, they were all treated with corticosteroids, primarily dexamethasone.…”

Section: Discussionmentioning

confidence: 99%

Cortisol Levels During First Admission Day Are Associated With Clinical Outcomes in Surgical Critically Ill Patients

Goder,

Gerstenhaber,

Gal Oz

et al. 2024

Critical Care Explorations

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IMPORTANCE: To explore the correlation between cortisol levels during first admission day and clinical outcomes. OBJECTIVES: Although most patients exhibit a surge in cortisol levels in response to stress, some suffer from critical illness-related corticosteroid insufficiency (CIRCI). Literature remains inconclusive as to which of these patients are at greater risk of poor outcomes. DESIGN: A retrospective study. SETTING: A surgical ICU (SICU) in a tertiary medical center. PARTICIPANTS: Critically ill patients admitted to the SICU who were not treated with steroids. MAIN OUTCOMES AND MEASURES: Levels of cortisol taken within 24 hours of admission (day 1 [D1] cortisol) in 1412 eligible patients were collected and analyzed. Results were categorized into four groups: low (0–10 µg/dL), normal (10–25 µg/dL), high (25–50 µg/dL), and very high (above 50 µg/dL) cortisol levels. Primary endpoint was 90-day mortality. Secondary endpoints were the need for organ support (use of vasopressors and mechanical ventilation [MV]), ICU length of stay (LOS), and duration of MV. RESULTS: The majority of patients (63%) had high or very high D1 cortisol levels, whereas 7.6% had low levels and thus could be diagnosed with CIRCI. There were statistically significant differences in 90-day mortality between the four groups and very high levels were found to be an independent risk factor for mortality, primarily in patients with Sequential Organ Failure Assessment (SOFA) less than or equal to 3 or SOFA greater than or equal to 7. Higher cortisol levels were associated with all secondary endpoints. CIRCI was associated with favorable outcomes. CONCLUSIONS AND RELEVANCE: In critically ill surgical patients D1 cortisol levels above 50 mcg/dL were associated with mortality, need for organ support, longer ICU LOS, and duration of MV, whereas low levels correlated with good clinical outcomes even though untreated. D1 cortisol level greater than 50 mcg/dL can help discriminate nonsurvivors from survivors when SOFA less than or equal to 3 or SOFA greater than or equal to 7.

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Section: Discussionmentioning

confidence: 99%

Cortisol Levels During First Admission Day Are Associated With Clinical Outcomes in Surgical Critically Ill Patients

Goder,

Gerstenhaber,

Gal Oz

et al. 2024

Critical Care Explorations

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show abstract

“…Furthermore, a research study examining the clinical practices and patient outcomes related to CIRCI in patients with refractory shock revealed the existence of a noteworthy threshold that must be exceeded before considering CIRCI as a potential cause of shock. The study also suggested that the apparent underdiagnosis of CIRCI could be attributed to a reduced frequency of steroid administration in cases where there was a justifiable suspicion of CIRCI in patients experiencing shock [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

A Cross-Sectional Survey Study on the Diagnosis and Management of Critical Illness-Induced Corticosteroid Insufficiency in Saudi Arabia

Qutob,

Alaryni,

Alghamdi

et al. 2023

Cureus

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Background The presence of critical illness-induced corticosteroid insufficiency (CIRCI) is correlated with elevated concentrations of circulating biomarkers associated with inflammation and coagulation in multiple domains. The management of adrenal insufficiency remains a topic of ongoing debate and disagreement among endocrinologists and intensivists. This study aimed to assess the extent of understanding regarding CIRCI among endocrinologists and intensivists who are actively practicing in Saudi Arabia. Methods This is an online cross-sectional survey study that was conducted between June and August 2023 to assess knowledge of CIRCI among endocrinologists and intensivists working in Saudi Arabia. The questionnaire tool for this study was constructed based on a previous literature review. Binary logistic regression analysis was used to define factors that affect participants’ knowledge of CIRCI. Results A total of 76 physicians were involved in this study. Around 32.9% (n= 25) of the participants described CIRCI correctly as an impairment of the hypothalamic-pituitary axis during critical illness. Around 35.5% (n=27) of the participants identified that widespread use of corticosteroids in critically ill patients prompted the need to revisit the concept, diagnosis, and management of CIRCI, and a similar proportion of the participants (35.5%) (n=27) identified that the role of corticosteroids in the management of CIRCI in critically ill patients may be beneficial in selected cases. Around 42.1% (n=32) of the participants identified that CIRCI is specific to critically ill patients while AI can occur in any individual. Around 17.1% (n=13) of the participants confirmed that there is no task force agreement on whether corticosteroids should be used in adult patients with sepsis but without shock. The mean knowledge score of the study participants was 3.6 (sd: 2.2) out of 10, which demonstrates a weak level of knowledge of CIRCI (36.0%). Binary logistic regression analysis identified that physicians from the southern and western regions were less likely to be knowledgeable of CIRCI compared to physicians from the central region (p< 0.05). Conclusion The study revealed that the level of familiarity with CIRCI among endocrinologists and intensivists in Saudi Arabia fell short of the desired benchmark. Clinicians may opt to utilize delta cortisol levels following cosyntropin administration and random plasma cortisol levels as diagnostic measures for CIRCI, instead of relying on plasma-free cortisol or salivary cortisol levels in conjunction with plasma total cortisol. Adherence to customized treatment protocols is crucial to attain the most favorable results for patients.

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Critical Illness-Related Corticosteroid Insufficiency (CIRCI) among Patients with COVID-19 at a Tertiary Hospital: Clinical Characteristics and Outcomes

Cited by 2 publications

References 34 publications

Cortisol Levels During First Admission Day Are Associated With Clinical Outcomes in Surgical Critically Ill Patients

Cortisol Levels During First Admission Day Are Associated With Clinical Outcomes in Surgical Critically Ill Patients

A Cross-Sectional Survey Study on the Diagnosis and Management of Critical Illness-Induced Corticosteroid Insufficiency in Saudi Arabia

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