oa Southern African Journal of Anaesthesia and Analgesia - Adrenal insufficiency in critically ill septic patients at Dr George Mukhari Hospital : research



&lt;I&gt;Rationale:&lt;/I&gt; Adrenal insufficiency occurs with varying frequency in critically ill patients. It is usually associated with a high mortality and poor clinical outcome. &lt;BR&gt;&lt;I&gt;Objective:&lt;/I&gt; To determine the incidence of adrenal failure in patients with severe sepsis and septic shock admitted to our intensive care unit. &lt;BR&gt;&lt;I&gt;Design:&lt;/I&gt; Prospective observational study, over a two year period (June 2003 - June 2005). &lt;BR&gt;&lt;I&gt;Setting:&lt;/I&gt; University hospital multi-disciplinary intensive care unit in South Africa. &lt;BR&gt;&lt;I&gt;Patients:&lt;/I&gt; 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. &lt;BR&gt;&lt;I&gt;Interventions:&lt;/I&gt; None. <BR><I>Measurements and main results:&lt;/I&gt; 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. &lt;BR&gt;&lt;I&gt;Conclusion:&lt;/I&gt; 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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