Nadledvinové funkce u kriticky nemocnýchhematologických pacientů

Adrenal functions in critically illhematology patients

Aims.
Sepsis is the most common cause of death of hematology patients in intensive care units. Adrenalgland is potentially involved in sepsis. Impaired functions of adrenal gland can be caused by hemorrhage,tumor infiltration, drugs, and suppression after glucocorticoid treatment. The goal of the studywas to evaluate adrenal functions in a group of critically ill hematology patients. Patients andmethods.35 critically ill patients with hematological disease, mean age 57 ± 14 years, 20 of them were women.Mortality was 48.6% (17 died). We performed the 250 µg short intravenous corticotropin test and wedetermined plasma concentrations of cortisol before the test and 30 and 60 minutes after the test.According to the results patient were classified as having adrenal insufficiency or not. Results. Theincidence of adrenal insufficiency depends on the criteria used. Using a basal cortisol level lower than414 nmol/l (15 µg/dl) the incidence of adrenal insufficiency was 29%.Using basal cortisol level or cortisolresponse to corticotropin lower than 250 nmol/l (9 µg/dl), the incidence of adrenal insufficiency was54%. When we use both these criteria the incidence of adrenal insufficiency was 14% and all thesepatients died. Patients with adrenal insufficiency had higher mortality and significantly lower thrombocytescount. Conclusion. There is a high incidence of adrenal insufficiency in critical ill hematologypatients. These patients should undergo evaluation of adrenal functions to reveal patients with theneed of hydrocortisone treatment.

Key words:
adrenal insufficiency, hematology, critical care, intensive care unit, sepsis, cortisol, corticotropin