Relative adrenal insufficiency in patients with septic shock; a close took to practice patterns

Purpose: To assess patterns of practice in our institution specifically regarding corticosteroid deficiency diagnosis in patients with septic shock. Methods: Consecutive adult patients with vasopressor-dependent septic shock admitted to the medical intensive-care unit between January 2002 and September 2003 were studied. Relative adrenal insufficiency (RAI) was diagnosed by a random serum cortisol level <= 5 mu g/dL or by a random cortisol level between 15 and 34 mu g/dL and an increase in response to cosyntropin stimulation test (250 mu g) <= 9 mu g/dL. Results: Ninety-two patients were included in the Study. Mean (+/- SD) age was 59 18 years. Overall mortality was 53%. Relative adrenal insufficiency was suspected in 44 (48%) patients and confirmed in 25 (57%). Maximal doses of vasopressors; were comparable between groups but more patients in whom AT was suspected were on phenylephrine and/or vasopressin and more were treated with activated protein C (P <.05). Diagnosis of RAI was confirmed by a low basal cortisol (< 15 mu g/dL) in 12 (48%) patients, whereas a diagnosis of RAI was made by a lack of response to the stimulation test in the rest. Conclusions: Relative adrenal insufficiency was diagnosed in half of the patients investigated. Patients with presumed RAI were more likely to be on phenylephrine or vasopressin infusions and treated with activated protein C and had a longer intensive care unit stay but no difference in intensive care unit survival. (c) 2006 Elsevier Inc. All rights reserved.