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J Korean Soc Emerg Med > Volume 19(5); 2008 > Article
Journal of The Korean Society of Emergency Medicine 2008;19(5): 498-505.
Relative Adrenal Insufficiency in Postresuscitation Patients
Jin Joo Kim, Jong Hwan Shin, Yong Su Lim, Chung Kwon Kim, Jae Kwang Kim, Sung Youl Hyun, Hyuk Jun Yang, Gun Lee, Young Cheol Choi
1Department of Emergency Medicine, Gachon University Gil Hospital, Korea. kjk@gilhospital.com
2Department of Emergency Medicine, Seoul Metropolitan Boramae Hospital, Korea.
3Department of Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Korea.
ABSTRACT
PURPOSE:
Relative adrenal insufficiency is common in intensive care unit patients. Basal cortisol and the cortisol response following the injection of synthetic corticotropin were prospectively evaluated in postresuscitation patients after cardiac arrest.
METHODS:
This is a prospective cohort study of relative adrenal insufficiency of patients with return of spontaneous circulation (>24 hours) after cardiac arrest who were admitted to the intensive care unit over three-year period from January 2005 to December 2007. Relative adrenal insufficiency was measured the next day after return of spontaneous circulation following cardiac arrest.
RESULTS:
Seventy-five patients were included over three years. Relative adrenal insufficiency developed in 41 patients. In patients with relative adrenal insufficiency, SOFA (sequential organ failure assessment) and lactate were elevated (p=0.03, 0.048), mortality was higher (p=0.014) and basal cortisol concentrations were significantly increased (p=0.001). In patients with therapeutic hypothermia, there were no significant differences with or without relative adrenal insufficiency (p=0.847). The factors associated with mortality, as assessed by multiple logistic regression were relative adrenal insufficiency, therapeutic hypothermia and the time from arrest to the start of cardiopulmonary resuscitation.
CONCLUSION:
Both basal cortisol and the cortisol response after the injection of synthetic corticotropine must be considered in predicting patients outcome. For patients with relative adrenal insufficiency, some specific treatments such as cortisol can be considered. More prospective multicenter study is needed.
Key words: Adrenal insufficiency, Cardiac arrest, Hypothermia
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