Intensive Care Medicine

, Volume 31, Issue 5, pp 627–633

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

Authors

    • Medical Intensive Care Unit, Cochin University HospitalAssistance Publique-Hôpitaux de Paris
    • Paris V University
  • Hervé Hyvernat
    • Medical Intensive Care Unit, Cochin University HospitalAssistance Publique-Hôpitaux de Paris
  • Vincent Mallet
    • Medical Intensive Care Unit, Cochin University HospitalAssistance Publique-Hôpitaux de Paris
    • Paris V University
  • Alain Cariou
    • Medical Intensive Care Unit, Cochin University HospitalAssistance Publique-Hôpitaux de Paris
    • Paris V University
  • Pierre Carli
    • SAMU 75, Necker University HospitalAssistance Publique-Hôpitaux de Paris
    • Paris V University
  • Christian Spaulding
    • Department of Cardiology, Cochin University HospitalAssistance Publique-Hôpitaux de Paris
    • Paris V University
  • Marie-Annick Dugue
    • Department of Hormonal Biochemistry, Cochin University HospitalAssistance Publique-Hôpitaux de Paris
  • Jean-Paul Mira
    • Medical Intensive Care Unit, Cochin University HospitalAssistance Publique-Hôpitaux de Paris
    • Paris V University
    • Cochin Institute INSERM U567
Original

DOI: 10.1007/s00134-005-2603-7

Cite this article as:
Pene, F., Hyvernat, H., Mallet, V. et al. Intensive Care Med (2005) 31: 627. doi:10.1007/s00134-005-2603-7

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 arrestCardiopulmonary resuscitationAdrenal insufficiencyShock

Copyright information

© Springer-Verlag 2005