oa Southern African Journal of Anaesthesia and Analgesia - Adrenal insufficiency in critically ill septic patients at Dr George Mukhari Hospital : research
<I>Rationale:</I> Adrenal insufficiency occurs with varying frequency in critically ill patients. It is usually associated with a high mortality and poor clinical outcome. <BR><I>Objective:</I> To determine the incidence of adrenal failure in patients with severe sepsis and septic shock admitted to our intensive care unit. <BR><I>Design:</I> Prospective observational study, over a two year period (June 2003 - June 2005). <BR><I>Setting:</I> University hospital multi-disciplinary intensive care unit in South Africa. <BR><I>Patients:</I> One hundred and fifty-two patients with severe sepsis and septic shock. Patients with a history of adrenal insufficiency, those on steroid therapy and all those who received etomidate within a week prior to enrollment were excluded. <BR><I>Interventions:</I> None. <BR><I>Measurements and main results:</I> A random plasma cortisol level was measured in consecutive patients with severe sepsis and septic shock. Adrenal insufficiency was defined as a cortisol level below 20µg/dL. The incidence of adrenal insufficiency was 26, 97% (CI: 19, 97% - 34, 03%). Patients with adrenal insufficiency had lower APACHE II scores and better short-term survival rates. The occurrence of adrenal dysfunction in patients with septic shock was low with an incidence of 15.6%. The type of infecting organism, site of infection and the origin of the sepsis were not associated with differences in the incidence of adrenal deficiency. <BR><I>Conclusion:</I> Absolute adrenal insufficiency is not uncommon among our critically septic patients. The presence of adrenal failure was inversely correlated with illness severity and mortality.
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