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Subclinical hypocortisolemia in patients with sepsis in a medical intensive care unit in India (The SHIPS Study)

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Author(s): Chacko Sujith | John George | Thomas Nihal | Nellickal Arun

Journal: Indian Journal of Critical Care Medicine
ISSN 0972-5229

Volume: 8;
Issue: 3;
Start page: 162;
Date: 2004;
Original page

Keywords: Hypocortisolemia; Septic Shock; Adrenal insufficiency

ABSTRACT
OBJECTIVES: (1) To determine the prevalence of relative adrenal insufficiency in critically ill patients in shock requiring vasopressors for more than 24 hrs, to maintain a mean arterial pressure of 70 mm of Hg. (2) To identify possible risk factors (markers) of a poor cortisol response. METHODOLOGY: A prospective analysis of 49 critically ill vasopressor dependant patients was performed. A 1 mcg of Synacthen stimulation test was performed and the cortisol response was assessed at 30′ and 60′. The criterion of minimum increment in the cortisol response of 9 mcg/dl was used to identify those with relative adrenal insufficiency. The patients were followed up until the time of discharge from hospital. Survival and morbidity indices were the final outcome measures assessed. RESULTS: The prevalence of relative adrenal insufficiency in this study was 81.6%. The mean basal cortisol value was 23.24 and the mean cortisol response was 6.22.The mean age (41.95 vs. 50.98), APACHE Score (16.63 vs. 16.44), pH (7.32 vs. 7.36) and sodium levels (135.55 vs. 134) were not significantly different between poor responders and good responders. CONCLUSIONS: (1) Relative adrenal insufficiency (hypocortisolemia) in vasopressor dependant critically ill patients is common (>80%). (2) In view of the high prevalence of hypocortisolemia in prolonged critical illness (as demonstrated by this study) and recent literature demonstrating benefit with replacement of glucocorticoids and mineralocorticoids in patients with relative adrenal insufficiency, it may be worthwhile considering steroid replacement in Indian patients in an ICU setting.

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