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Prognostic value of relative adrenal insufficiency after out-of-hospital cardiac arrest.

Abstract：

OBJECTIVE:To assess the prevalence of relative adrenal insufficiency in patients successfully resuscitated after cardiac arrest, and its prognostic role in post-resuscitation disease. DESIGN AND SETTING:A prospective observational single-center study in a medical intensive care unit. PATIENTS:64 patients hospitalised in the intensive care unit after successful resuscitation for out-of-hospital cardiac arrest. MEASUREMENTS AND RESULTS:A corticotropin-stimulation test was performed between 12 and 24 h following admission: serum cortisol level was measured before and 60 min after administration of tetracosactide 250 microg. Patients with an incremental response less than 9 microg/dl were considered to have relative adrenal insufficiency (non-responders). Variables were expressed as medians and interquartile ranges. 33 patients (52%) had relative adrenal insufficiency. Baseline cortisol level was higher in non-responders than in responders (41 [27.2-55.5] vs. 22.8 [15.7-35.1] microg/dl respectively, P=0.001). A long interval before initiation of cardiopulmonary resuscitation was associated with relative adrenal insufficiency (5 [3-10] vs. 3 [3-5] min, P=0.03). Of the 38 patients with post-resuscitation shock, 13 died of irreversible multiorgan failure. The presence of relative adrenal insufficiency was identified as a poor prognostic factor of shock-related mortality (log-rank P=0.02). A trend towards higher mortality in non-responders was identified in a multivariate logistic regression analysis (odds ratio 6.77, CI 95% 0.94-48.99, P=0.058). CONCLUSIONS:Relative adrenal insufficiency occurs frequently after successful resuscitation of out-of-hospital cardiac arrest, and appears to be associated with a poor prognosis in cases of post-resuscitation shock. The role of corticosteroid supplementation should be evaluated in this setting.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Pene F,Hyvernat H,Mallet V,Cariou A,Carli P,Spaulding C,Dugue MA,Mira JP

doi

10.1007/s00134-005-2603-7

keywords:

subject

Has Abstract

pub_date

2005-05-01 00:00:00

pages

627-33

issue

5

eissn

0342-4642

issn

1432-1238

journal_volume

31

pub_type

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