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KMID : 0364020180510020109
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Korean Journal of Thoracic and Cardiovascular Surgery
2018 Volume.51 No. 2 p.109 ~ p.113
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Critical Illness-Related Corticosteroid Insufficiency in Patients with Low Cardiac Output Syndrome after Cardiac Surgery
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Ok You-Jung
Lim Ju-Yong
Jung Sung-Ho
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Abstract
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Background: Low cardiac output syndrome (LCOS) after cardiac surgery usually requires inotropes. In this setting, critical illness-related corticosteroid insufficiency (CIRCI) may develop. We aimed to investigate the clinical features of CIRCI in the presence of LCOS and to assess the efficacy of steroid treatment.
Methods: We reviewed 28 patients who underwent a rapid adrenocorticotropic hormone (ACTH) test due to the suspicion of CIRCI between February 2010 and September 2014. CIRCI was diagnosed by a change in serum cortisol of ＜9 μg/dL after the ACTH test or a random cortisol level of ＜10 μg/dL.
Results: Twenty of the 28 patients met the diagnostic criteria. The patients with CIRCI showed higher Sequential Organ Failure Assessment (SOFA) scores than those without CIRCI (16.1±2.3 vs. 11.4±3.5, p=0.001). Six of the patients with CIRCI (30%) received glucocorticoids. With an average elevation of the mean blood pressure by 22.2±8.7 mm Hg after steroid therapy, the duration of inotropic support was shorter in the steroid group than in the non-steroid group (14.1±2.3 days versus 30±22.8 days, p=0.001). Three infections (15%) developed in the non-steroid group, but this was not a significant between-group difference.
Conclusion: CIRCI should be suspected in patients with LCOS after cardiac surgery, especially in patients with a high SOFA score. Glucocorticoid replacement therapy may be considered to reduce the use of inotropes without posing an additional risk of infection.
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KEYWORD
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Critical illness, Adrenal insufficiency, Low cardiac output syndrome, Corticosteroids, Wound infection
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