Corticosteroid Insufficiency in Septic Shock Patients in Pathum Thani Hospital - Corticosteroid Insufficiency ในผู้ป่วยช็อก จากการติดเชื้อ โรงพยาบาลปทุมธานี

Abstract

        Critical illness-related corticosteroid insufficiency (CIRCI) was defined in 2008 by American College of Critical Care Medicine and diagnosed by using baseline serum cortisol of less than 10 μg/dl or delta serum cortisol of less than 9 μg/dl after adrenocorticotrophic hormone (ACTH) stimulation test. In Thailand, there were limited data published and steroid abuse was common which might affect this condition. This retrospective study was conducted in adult patients admitted with septic shock who had serum cortisol collected at that time in Pathum Thani hospital during January 2009 - December 2011. Of the 116 cases, the prevalence of CIRCI was 19 percent and it was 21.7 percent in the group that suspected to be steroid abuse, comparing to 17.8 percent in the other group. Both groups were not quite different in clinical characteristics. There were less respiratory failure, hyponatremia and hyperkalemia but more hypoglycemia and eosinophilia in CIRCI group. Treatment with hydrocortisone caused higher blood-pressure response at 48 hours especially if cortisol level was less than 35 μg/dl but mortality rate in relation to cortisol level was not different. CIRCI mortality rate was 27.3 percent. In septic shock patients, the prevalence of CIRCI was 19 percent. Hypoglycemia and eosinophilia were uncommon but might alert the possibility of corticosteroid insufficiency. History of suspected to be steroid abuse did not affect outcome. Hydrocortisone treatment caused more blood pressure response at 48 hours but did not decrease mortality. Its use should be according to recommendation which is to provide to cases identified to be poorly responsive to fluid and vasopressor therapy.
Keywords: corticosteroid insufficiency, septic shock, glucocorticoid, steroid, adrenal insufficiency