SAT289 Prevalence And Treatment Outcomes of Critical Illness-related Corticosteroid Insufficiency (CIRCI) In Septic Shock Patients In Medical Wards And Emergency Room In Thammasat University Hospital

Abstract

Abstract Disclosure: K. Sanpawithayakul: None. K. Meepornbucha: None. P. Pirompanich: None. P. Vibhatavata: None. Background: The reported prevalence of critical illness-related corticosteroid insufficiency (CIRCI) varies widely, depending on the patient population studied and the diagnostic criteria used. Although hydrocortisone (HC) is widely used in patients with septic shock who respond poorly to adequate fluid resuscitation and vasopressors, clinical outcomes remain controversial. Objectives: To investigate the prevalence of CIRCI and to evaluate characteristics of septic shock patients treated with HC due to suspicion of CIRCI as compared to septic shock patients without CIRCI. Material and Method: Retrospective analysis of septic shock patients admitted in medical wards in Thammasat University Hospital, from January 2020 to June 2021, was performed. Prevalence of CIRCI in septic shock patients was explored by using different serum cortisol cutoff at 10 μg/dL (C-10) and 18 μg/dL (C-18), respectively. 28-day mortality, duration of hospital and intensive care unit (ICU) admission, mechanical ventilator usage, need for vasopressor support, and complications of HC use were also analyzed. Results: Of the 252 septic shock patients, 68 patients were met our inclusion criteria. Eight (11.8%) and 20 (29.4%) patients was diagnosed with CIRCI by serum cortisol cutoff 10 and 18 µg/dL, respectively. There were no significant differences in baseline characteristics (i.e., age, sex and preexisting diseases) between groups. Of the septic shock patients without CIRCI diagnosed by C-18 cutoff, initial SOFA and APACHE II, serum creatinine and lactate were significantly higher. Moreover, 28-day mortality rate was statistically higher in patients without CIRCI by C-18 cutoff (70.8% vs 40.0%, p=0.03). Multivariate analysis recognized the the amount of vasopressor use as significant predictor of 28-day mortality, with OR 19.04 (95%CI 1.23-293.80, p=0.04) and 19.34 (95% CI 1.27-293.50, p=0.03) in C-10 and C-18, respectively. However, in-patient mortality was not statistically different between groups regardless of the cortisol cutoff. Conclusion: Using a 18-C cutoff, there was a higher mortality rate in patients without CIRCI. Keyword: Septic shock, CIRCI, critical illness-related corticosteroid insufficiency Presentation: Saturday, June 17, 2023