Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2015) 37 GP01.06 | DOI: 10.1530/endoabs.37.GP.01.06

ECE2015 Guided Posters Adrenal (8 abstracts)

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

Manish Gutch 1 , Sukriti Kumar 2 , Syed Mohd Razi 1 , Abhinav Gupta 1 & Keshav Kumar Gupta 1


1LLRM Medical College, Meerut, Uttar Pradesh, India; 2SGPGI, Lucknow, India.


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: 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 done at tertiary care centre.

Methods and materials: In patients of septic shock, APACHE II score was calculated and serum cortisol was measured at the time of admission and 1 h after giving 250 μg 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: i) absolute AI – baseline cortisol <20 μg/dl and increment ≤9 μg/dl after the ACTH stimulation test and ii) relative AI – patients with baseline cortisol ≥20 μg/dl and increment ≤9 μg/dl. Statistical analysis used: data were analysed with SPSS version 17 and were presented in the values of mean, median, and percentages. The P value of <0.05 was considered significant.

Results: The incidence of AI in septic shock was (n=100) was 42% (in absolute 14% and relative 28%). The incidence of AI in septic shock was 42% (absolute 14% and 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 longer period in relative as compared with 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.

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