Relative adrenal insufficiency in patients with septic shock; a close look to practice patterns

Abstract

Purpose To assess patterns of practice in our institution specifically regarding corticosteroid deficiency diagnosis in patients with septic shock. Methods Consecutive adult patients with vasopressor-dependent septic shock admitted to the medical intensive care unit between January 2002 and September 2003 were studied. Relative adrenal insufficiency (RAI) was diagnosed by a random serum cortisol level ≤15 μg/dL or by a random cortisol level between 15 and 34 μg/dL and an increase in response to cosyntropin stimulation test (250 μg) ≤9 μg/dL. Results Ninety-two patients were included in the study. Mean (±SD) age was 59 ± 18 years. Overall mortality was 53%. Relative adrenal insufficiency was suspected in 44 (48%) patients and confirmed in 25 (57%). Maximal doses of vasopressors were comparable between groups but more patients in whom AI was suspected were on phenylephrine and/or vasopressin and more were treated with activated protein C ( P < .05). Diagnosis of RAI was confirmed by a low basal cortisol (<15 μg/dL) in 12 (48%) patients, whereas a diagnosis of RAI was made by a lack of response to the stimulation test in the rest. Conclusions Relative adrenal insufficiency was diagnosed in half of the patients investigated. Patients with presumed RAI were more likely to be on phenylephrine or vasopressin infusions and treated with activated protein C and had a longer intensive care unit stay but no difference in intensive care unit survival.