Prognostic value of relative adrenal insufficiency after out-of-hospital cardiac arrest
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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.
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 µg. Patients with an incremental response less than 9 µg/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] µg/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).
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
- Prognostic value of relative adrenal insufficiency after out-of-hospital cardiac arrest
Intensive Care Medicine
Volume 31, Issue 5 , pp 627-633
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- Print ISSN
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- Cardiac arrest
- Cardiopulmonary resuscitation
- Adrenal insufficiency
- Industry Sectors
- Author Affiliations
- 1. Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75679, Paris Cedex 14, France
- 5. Paris V University, Paris, France
- 2. SAMU 75, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- 3. Department of Cardiology, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- 4. Department of Hormonal Biochemistry, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- 6. Cochin Institute INSERM U567, Paris, France