Incidence of adrenal insufficiency and its relation to mortality in patients with septic shock

Abstract

Background: The hypothalamic pituitary adrenal axis has a pivotal role in combating acute insults. Glucocorticoids play a role directly or indirectly in the maintenance of normal vascular tone and in potentiating the vasoconstrictor action of catecholamine, associated with septic shock. Aims: The aim was to determine the incidence of adrenal insufficiency (AI) and its relation to mortality in patients with septic shock. Settings and Design: A prospective observational study carried out at Tertiary Care Center. Materials and Methods: In patients of septic shock, acute physiology and chronic health evaluation II (APACHE II) score was calculated and serum cortisol was measured at the time of admission and 1 h after giving 250 μg adrenocorticotrophin hormone (ACTH). Hydrocortisone was added to inotropics in all patients after drawing second blood sample for serum cortisol and was continued till 7 days or less. In our study, the patients with inadequate adrenal response were divided into two groups: (1) Absolute AI - baseline cortisol Statistical Analysis Used: Data were analyzed with SPSS version 17 and were presented in the values of mean, median, and percentages. P Results: The incidence of AI in septic shock was ( N = 100) was 42% (in absolute 14%, relative 28%).The incidence of AI in septic shock was 42% (absolute 14%, relative 28%). The mortality rate was 48%, and it was higher in patients with AI than in patients without AI ( P = 0.017). The APACHE II score >25 carried higher mortality rate than a score of ≤25 ( P ≤ 0.001). Baseline serum cortisol >45 μg/dl had exceptionally high likelihood of mortality (OR: 50, P ≤ 0.001). Among those who survived, inotropic support was required for a longer period in relative when compared to absolute AI and to non-AI. Conclusions: AI is prevalent among patients with septic shock. We found that higher APACHE scores were associated with higher rates of adrenal failure and mortality in patients with septic shock. There also appears to be a bimodal distribution of mortality with adrenal status in patients with septic shock.