Journal of Medical and Surgical Intensive Care Medicine 2019 , Vol 10, Issue 2
Low Cortisol Levels as a Cause of Hypotension During Extended ICU Stay
Leyla TALAN 1 ,Göksel GÜVEN 1 ,Neriman Defne ALTINTAŞ1 1
11Ankara University Faculty of Medicine, Internal Medicine, Intensive Care, Ankara, Turkey DOI : 10.33381/dcbybd.2019.2008 Aim: To determine the prevalence of newly developed low cortisol levels among critically ill medical patients with prolonged or recurrent vasopressor need as well as the factors associated with it.

Materials and Methods: This was an observational study which was conducted in a university hospital’s medical intensive care unit (ICU) between July 2014 - July 2015. Initial cortisol levels were measured in septic shock patients unresponsive to fluid resuscitation and vasopressors. Patients with initial cortisol levels ≥15 μg/dl were followed; testing was repeated in patients with ongoing/recurrent vasopressor dependency. Patients were grouped as higher (≥15 μg/dl ) and lower (<15 μg/dl) cortisol groups based on repeat testing.

Results: Thirty-seven patients had initial cortisol levels ≥15 μg/dl and 19 patients underwent cortisol retesting for ongoing/recurrent vasopressor need. Mean (±SD) age of the patients was 70±13.5 years. APACHE II and Sequential Organ Failure Assessment scores on ICU admission were 25.3±6.5 and 10.4±5.2, respectively. Eleven (%58) were in the lower cortisol group. Age, gender, admission APACHEII and SOFA scores, serum albumin, protein, C-reactive protein and procalcitonin levels at time of admission and repeat sampling were similar between the groups. However, at the time of cortisol retesting, patients with lower cortisol levels had significantly longer length of ICU stay (p=0.038). When glucocorticoid therapy was begun in lower cortisol group, vasopressors were weaned within 48 hours in all.

Conclusion: Prolonged or recurrent vasopressor dependency should prompt a search for low cortisol levels in patients with prolonged critical illness, even though prior results were reported to be normal. Keywords : Critical Illness,Cortisol,Septic Shock,Vasoconstrictor Agents