Original

Intensive Care Medicine

, Volume 31, Issue 5, pp 627-633

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

  • Frédéric PeneAffiliated withMedical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de ParisParis V University Email author 
  • , Hervé HyvernatAffiliated withMedical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris
  • , Vincent MalletAffiliated withMedical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de ParisParis V University
  • , Alain CariouAffiliated withMedical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de ParisParis V University
  • , Pierre CarliAffiliated withSAMU 75, Necker University Hospital, Assistance Publique-Hôpitaux de ParisParis V University
  • , Christian SpauldingAffiliated withDepartment of Cardiology, Cochin University Hospital, Assistance Publique-Hôpitaux de ParisParis V University
  • , Marie-Annick DugueAffiliated withDepartment of Hormonal Biochemistry, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris
  • , Jean-Paul MiraAffiliated withMedical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de ParisParis V UniversityCochin Institute INSERM U567

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

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 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).

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

Keywords

Cardiac arrest Cardiopulmonary resuscitation Adrenal insufficiency Shock