Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 5/2005

01-05-2005 | Original

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

Authors: Frédéric Pene, Hervé Hyvernat, Vincent Mallet, Alain Cariou, Pierre Carli, Christian Spaulding, Marie-Annick Dugue, Jean-Paul Mira

Published in: Intensive Care Medicine | Issue 5/2005

Login to 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
Literature
1.
Cooper MS, Stewart PM (2003) Corticosteroid insufficiency in acutely ill patients. N Engl J Med 348:727–734
2.
Rothwell PM, Udwadia ZF, Lawler PG (1991) Cortisol response to corticotropin and survival in septic shock. Lancet 337:582–583
3.
Annane D, Bellissant E (2000) Prognostic value of cortisol response in septic shock. JAMA 284:308–309
4.
Hoen S, Asehnoune K, Brailly-Tabard S, Mazoit JX, Benhamou D, Moine P, Edouard AR (2002) Cortisol response to corticotropin stimulation in trauma patients: influence of hemorrhagic shock. Anesthesiology 97:807–813
5.
Marik PE, Kiminyo K, Zaloga GP (2002) Adrenal insufficiency in critically ill patients with human immunodeficiency virus. Crit Care Med 30:1267–1273
6.
Dimopoulou I, Tsagarakis S, Kouyialis AT, Roussou P, Assithianakis G, Christoforaki M, Ilias I, Sakas DE, Thalassinos N, Roussos C (2004) Hypothalamic-pituitary-adrenal axis dysfunction in critically ill patients with traumatic brain injury: incidence, pathophysiology, and relationship to vasopressor dependence and peripheral interleukin-6 levels. Crit Care Med 32:404–408
7.
Dimopoulou I, Tsagarakis S, Anthi A, Milou E, Ilias I, Stavrakaki K, Charalambidis C, Tzanela M, Orfanos S, Mandragos K, Thalassinos N, Roussos C (2003) High prevalence of decreased cortisol reserve in brain-dead potential organ donors. Crit Care Med 31:1113–1117
8.
Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, Chaumet-Riffaut P, Bellissant E (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862–871
9.
Eisenberg MS, Mengert TJ (2001) Cardiac resuscitation. N Engl J Med 344:1304–1313
10.
Negovsky VA (1988) Postresuscitation disease. Crit Care Med 16:942–946
11.
Laurent I, Monchi M, Chiche JD, Joly LM, Spaulding C, Bourgeois B, Cariou A, Rozenberg A, Carli P, Weber S, Dhainaut JF (2002) Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol 40:2110–2116
12.
Adrie C, Adib-Conquy M, Laurent I, Monchi M, Vinsonneau C, Fitting C, Fraisse F, Dinh-Xuan AT, Carli P, Spaulding C, Dhainaut JF, Cavaillon JM (2002) Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome. Circulation 106:562–568
13.
Spaulding CM, Joly LM, Rosenberg A, Monchi M, Weber SN, Dhainaut JF, Carli P (1997) Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med 336:1629–1633
14.
14 Anonymous (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556
15.
Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563
16.
Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
17.
Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D (1996) The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA 276:802–810
18.
Safar P (1988) Resuscitation from clinical death: pathophysiologic limits and therapeutic potentials. Crit Care Med 16:923–941
19.
Adrie C, Laurent I, Monchi M, Cariou A, Dhainaou JF, Spaulding C (2004) Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care 10:208–212
20.
Schultz CH, Rivers EP, Feldkamp CS, Goad EG, Smithline HA, Martin GB, Fath JJ, Wortsman J, Nowak RM (1993) A characterization of hypothalamic-pituitary-adrenal axis function during and after human cardiac arrest. Crit Care Med 21:1339–1347
21.
Lindner KH, Strohmenger HU, Ensinger H, Hetzel WD, Ahnefeld FW, Georgieff M (1992) Stress hormone response during and after cardiopulmonary resuscitation. Anesthesiology 77:662–668
22.
Krismer AC, Wenzel V, Voelckel WG, Stadlbauer KH, Wagner-Berger H, Schaefer A, Lindner KH (2003) Effects of vasopressin on adrenal gland regional perfusion during experimental cardiopulmonary resuscitation. Resuscitation 56:223–228
23.
Kornberger E, Prengel AW, Krismer A, Schwarz B, Wenzel V, Lindner KH, Mair P (2000) Vasopressin-mediated adrenocorticotropin release increases plasma cortisol concentrations during cardiopulmonary resuscitation. Crit Care Med 28:3517–3521
24.
Wenzel V, Krismer AC, Arntz HR, Sitter H, Stadlbauer KH, Lindner KH (2004) A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 350:105–113
25.
Marik PE, Zaloga GP (2002) Adrenal insufficiency in the critically ill: a new look at an old problem. Chest 122:1784–1796
26.
Hamrahian AH, Oseni TS, Arafah BM (2004) Measurements of serum free cortisol in critically ill patients. N Engl J Med 350:1629–1638
27.
Absalom A, Pledger D, Kong A (1999) Adrenocortical function in critically ill patients 24 h after a single dose of etomidate. Anaesthesia 54:861–867
28.
Chi OZ, Choi YK, Lee DI, Kim YS, Lee I (2001) Intraoperative mild hypothermia does not increase the plasma concentration of stress hormones during neurosurgery. Can J Anaesth 48:815–818
29.
Beilin B, Shavit Y, Razumovsky J, Wolloch Y, Zeidel A, Bessler H (1998) Effects of mild perioperative hypothermia on cellular immune responses. Anesthesiology 89:1133–1140
30.
Bollaert PE, Charpentier C, Levy B, Debouverie M, Audibert G, Larcan A (1998) Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med 26:645–650
31.
Giugliano GR, Giugliano RP, Gibson CM, Kuntz RE (2003) Meta-analysis of corticosteroid treatment in acute myocardial infarction. Am J Cardiol 91:1055–1059
32.
Hafezi-Moghadam A, Simoncini T, Yang E, Limbourg FP, Plumier JC, Rebsamen MC, Hsieh CM, Chui DS, Thomas KL, Prorock AJ, Laubach VE, Moskowitz MA, French BA, Ley K, Liao JK (2002) Acute cardiovascular protective effects of corticosteroids are mediated by non-transcriptional activation of endothelial nitric oxide synthase. Nat Med 8:473–479
33.
Schurr A (2001) Glucose and the ischemic brain: a sour grape or a sweet treat? Curr Opin Clin Nutr Metab Care 4:287–292
34.
Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC (2001) Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 32:2426–2432
35.
Norhammar AM, Ryden L, Malmberg K (1999) Admission plasma glucose. Independent risk factor for long-term prognosis after myocardial infarction even in nondiabetic patients. Diabetes Care 22:1827–1831
36.
Wahab NN, Cowden EA, Pearce NJ, Gardner MJ, Merry H, Cox JL (2002) Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? J Am Coll Cardiol 40:1748–1754
37.
Malmberg K (1997) Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ 314:1512–1515
38.
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345:1359–1367
Metadata
Title
Prognostic value of relative adrenal insufficiency after out-of-hospital cardiac arrest
Authors
Frédéric Pene
Hervé Hyvernat
Vincent Mallet
Alain Cariou
Pierre Carli
Christian Spaulding
Marie-Annick Dugue
Jean-Paul Mira
Publication date
01-05-2005
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 5/2005
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-005-2603-7

Other articles of this Issue 5/2005

Intensive Care Medicine 5/2005 Go to the issue

Brief Report

Weaning failure from mechanical ventilation due to hypertrophic obstructive cardiomyopathy

Original

Small increases in the urinary excretion of glutathione S-transferase A1 and P1 after cardiac surgery are not associated with clinically relevant renal injury

Technical Note

Intra- and interobserver variability during in vitro validation of two novel methods for intra-abdominal pressure monitoring

Editorial

Intensive Care Medicine: what we offer to our readers and what the readers think of it

Experimental

Pentoxifylline does not improve outcome in a murine model for the multiple-organ dysfunction syndrome

Experimental

Blockade of nuclear factor-κB activation prevents hypodynamic shock and gastric hypoperfusion induced by endotoxin in anesthetized dogs