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Critical illness-related corticosteroid insufficiency in cancer patients

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Abstract

Purpose

Critically ill cancer patients with sepsis represent a high-risk sub-group for the development of critical illness-related corticosteroid insufficiency (CIRCI); however, the incidence of CIRCI in this population is unknown. The purpose of this study was to determine the incidence of CIRCI in cancer patients with severe sepsis or septic shock.

Methods

A single-center, retrospective, observational study was conducted in a 52-bed medical–surgical intensive care unit of a National Cancer Institute-recognized academic oncology institution. Eighty-six consecutive patients with a diagnosis of severe sepsis or septic shock who received a high-dose 250-μg cosyntropin stimulation test were included. CIRCI was identified by a maximum delta serum cortisol of 9 μg/dL or less post cosyntropin.

Results

Overall, 59% (95% CI, 48–70%) of cancer patients with severe sepsis or septic shock were determined to have CIRCI. When compared to patients without CIRCI, patients with CIRCI had higher baseline serum cortisol (median, 26.3 versus 14.7 μg/dL; p = 0.002) and lower delta cortisol levels (median, 3.1 versus 12.5 μg/dL; p < 0.001). Mortality did not differ between the two groups. An inverse relationship was identified between baseline serum cortisol and maximum delta cortisol (maximum delta cortisol = −0.27 × baseline cortisol + 14.30; R 2 = 0.208, p < 0.001).

Conclusions

The incidence of CIRCI in cancer patients with severe sepsis or septic shock appears high. Further large-scale prospective trials are needed to confirm these findings.

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Abbreviations

ACCM:

American College of Critical Care Medicine

AI:

Adrenal insufficiency

AMS:

Altered mental status

APACHE:

Acute Physiology and Chronic Health Evaluation score

BC:

Baseline serum cortisol

CIRCI:

Critical illness-related corticosteroid insufficiency

CORTICUS:

Corticosteroid Therapy of Septic Shock

GI:

Gastrointestinal

HPA:

Hypothalamus–pituitary–adrenal gland axis

LOS:

Length of stay

MDACC:

MD Anderson Cancer Center

MDC:

Maximum delta cortisol

MICU:

Medical intensive care unit

OR:

Odds ratio

SICU:

Surgical intensive care unit

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Acknowledgments

The authors thank the medical and surgical ICU nursing staff for their invaluable support of this study.

Conflict of interest

The authors have no conflicts of interest regarding this publication.

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Authors and Affiliations

  1. Division of Pharmacy, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 377, Houston, TX, 77030-4009, USA

    Jeffrey Joseph Bruno

  2. Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mike Hernandez

  3. Clinical Research Program, Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Shubhra Ghosh

  4. Critical Care Medicine, Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    S. Egbert Pravinkumar

Authors
  1. Jeffrey Joseph Bruno
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  2. Mike Hernandez
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  3. Shubhra Ghosh
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  4. S. Egbert Pravinkumar
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Corresponding author

Correspondence to Jeffrey Joseph Bruno.

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Bruno, J.J., Hernandez, M., Ghosh, S. et al. Critical illness-related corticosteroid insufficiency in cancer patients. Support Care Cancer 20, 1159–1167 (2012). https://doi.org/10.1007/s00520-011-1191-z

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  • DOI: https://doi.org/10.1007/s00520-011-1191-z

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