Hashemi-Madani Nahid, Miri Marzieh, Emami Zahra, Barati Mitra, Golgiri Fatemeh
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
Paediatric Infectious Diseases Research Centre, Iran University of Medical Science, Tehran, Iran.
Med J Islam Repub Iran. 2021 Nov 20;35:154. doi: 10.47176/mjiri.35.154. eCollection 2021.
Adrenal insufficiency (AI) is associated with an increase in the risk of mortality in ICU-admitted septic patients. It should be suspected not only in patients with septic shock but also in those with sepsis. The aim of this study was to investigate the prevalence of AI in the spectrum of septic patients and determine the main predictors of this condition. This study included 99 patients with the diagnosis of sepsis, severe sepsis, or septic shock. Patients with basal cortisol < 10 μg/dl or those with ∆ cortisol < 9 μg/dl after the cosyntropin test were considered as having AI. Appropriate statistical tests were used for comparing the variables between the two groups. A logistic regression model was applied to determine the predictors of AI. The P-value <0.05 was considered as a significant level. AI was found in 25 (25.3%) of these patients. There was no significant difference in the occurrence of AI in patients with sepsis, severe sepsis, or septic shock. Patients with positive blood culture (OR (95% CI); 7.8 (3.5-9.1); p=0.021) or those with CRP≥ 3+ (OR (95% CI); 14.1 8 (5.7-16.2); p<0.001) were more likely to develop AI. AI is prevalent among ICU admitted septic patients even in the absence of septic shock. The main predictors of AI are high levels of CRP and positive blood culture.
肾上腺功能不全（AI）与入住重症监护病房（ICU）的脓毒症患者死亡率增加相关。不仅脓毒性休克患者，脓毒症患者也应怀疑患有AI。本研究的目的是调查脓毒症患者中AI的患病率，并确定该病症的主要预测因素。本研究纳入了99例诊断为脓毒症、严重脓毒症或脓毒性休克的患者。基础皮质醇<10μg/dl的患者或促肾上腺皮质激素试验后皮质醇变化量<9μg/dl的患者被视为患有AI。采用适当的统计检验比较两组之间的变量。应用逻辑回归模型确定AI的预测因素。P值<0.05被视为显著水平。在这些患者中，有25例（25.3%）被发现患有AI。脓毒症、严重脓毒症或脓毒性休克患者中AI的发生率无显著差异。血培养阳性的患者（比值比（95%置信区间）；7.8（3.5 - 9.1）；p = 0.021）或CRP≥3+的患者（比值比（95%置信区间）；14.18（5.7 - 16.2）；p<0.001）更有可能发生AI。即使在没有脓毒性休克的情况下，AI在入住ICU的脓毒症患者中也很普遍。AI的主要预测因素是高CRP水平和血培养阳性。
