심정지 후 순환회복을 보인 환자에서의 상대적 부신기능 부전의 영향 (Relative Adrenal Insufficiency in Postresuscitation Patients)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 19권 / 5호 / 498 ~ 505페이지
· 저자명 : 김진주, 신종환, 임용수, 김정권, 현성열, 양혁준, 이근, 최영철, 김재광

초록

Purpose: Relative adrenal insufficiency is common in intensive
care unit patients. Basal cortisol and the cortisol
response following the injection of synthetic corticotropin
were prospectively evaluated in postresuscitation patients
after cardiac arrest.
Methods: This is a prospective cohort study of relative
adrenal insufficiency of patients with return of spontaneous
circulation (>24 hours) after cardiac arrest who were admitted
to the intensive care unit over three-year period from
January 2005 to December 2007. Relative adrenal insufficiency
was measured the next day after return of spontaneous
circulation following cardiac arrest.
Results: Seventy-five patients were included over three
years. Relative adrenal insufficiency developed in 41
patients. In patients with relative adrenal insufficiency,
SOFA (sequential organ failure assessment) and lactate
were elevated (p=0.03, 0.048), mortality was higher
(p=0.014) and basal cortisol concentrations were significantly
increased (p=0.001). In patients with therapeutic
hypothermia, there were no significant differences with or
without relative adrenal insufficiency (p=0.847). The factors
associated with mortality, as assessed by multiple logistic
regression were relative adrenal insufficiency, therapeutic
hypothermia and the time from arrest to the start of cardiopulmonary
resuscitation.
Conclusion: Both basal cortisol and the cortisol response
after the injection of synthetic corticotropine must be considered
in predicting patients outcome. For patients with relative
adrenal insufficiency, some specific treatments such as
cortisol can be considered. More prospective multicenter
study is needed.

영어초록

Purpose: Relative adrenal insufficiency is common in intensive
care unit patients. Basal cortisol and the cortisol
response following the injection of synthetic corticotropin
were prospectively evaluated in postresuscitation patients
after cardiac arrest.
Methods: This is a prospective cohort study of relative
adrenal insufficiency of patients with return of spontaneous
circulation (>24 hours) after cardiac arrest who were admitted
to the intensive care unit over three-year period from
January 2005 to December 2007. Relative adrenal insufficiency
was measured the next day after return of spontaneous
circulation following cardiac arrest.
Results: Seventy-five patients were included over three
years. Relative adrenal insufficiency developed in 41
patients. In patients with relative adrenal insufficiency,
SOFA (sequential organ failure assessment) and lactate
were elevated (p=0.03, 0.048), mortality was higher
(p=0.014) and basal cortisol concentrations were significantly
increased (p=0.001). In patients with therapeutic
hypothermia, there were no significant differences with or
without relative adrenal insufficiency (p=0.847). The factors
associated with mortality, as assessed by multiple logistic
regression were relative adrenal insufficiency, therapeutic
hypothermia and the time from arrest to the start of cardiopulmonary
resuscitation.
Conclusion: Both basal cortisol and the cortisol response
after the injection of synthetic corticotropine must be considered
in predicting patients outcome. For patients with relative
adrenal insufficiency, some specific treatments such as
cortisol can be considered. More prospective multicenter
study is needed.

참고자료

· 없음