Highlights
- •Adrenal crisis may indicate underlying chronic adrenal insufficiency.
- •The proportions of newly- versus previously-diagnosed chronic AI cases were similar.
- •Pre-existing chronic AI is related to a favorable outcome.
- •AI-related symptoms are a significant risk factor for in-hospital death.
Abstract
Background
Chronic adrenal insufficiency (AI) is an established risk factor for adrenal crisis
(AC). However, the proportion of patients with newly diagnosed chronic AI during admission
for AC is unclear.
Methods
This retrospective cohort study used a Japanese claims database involving 7.39 million
patients at 145 acute care hospitals between 2003 and 2014. Study patients with AC
met these criteria: 1) newly coded in claims as AI; 2) glucocorticoid therapy administered;
3) admission; and 4) age ≥ 18 years. We investigated the prevalence of underlying
chronic AI and assessed in-hospital mortality. Additionally, we explored risk factors
for in-hospital mortality through multivariate analysis using a Cox proportional hazards
model.
Results
Among 504 patients with AC, chronic AI was diagnosed before and during admission in
73 (14.5%) and 86 (17.1%) patients, respectively. In-hospital mortality rates were
1.4% and 5.8%, respectively, lower than that of the total population (14.1%). Significant
risk factors for increased mortality were: age (hazard ratio [HR] 1.45/10 years; 95%
confidence interval [CI] 1.17–1.78), requiring mechanical ventilation (HR 3.81; 95%
CI 1.88–7.72), vasopressor administration (HR 2.05; 95% CI 1.16–3.64), sepsis (HR
3.79; 95% CI 1.57–9.14), AI-related symptoms (HR 2.00; 95% CI 1.02–3.93), and liver
disease (HR 3.24; 95% CI 1.10–9.58).
Conclusions
Relative to patients without chronic AI, those diagnosed before admission tended to
survive to discharge; however, the difference with those diagnosed during admission
was not significant. Hospital admission due to nonspecific AI-related symptoms was
associated with an increased risk of in-hospital mortality.
Keywords
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Article info
Publication history
Published online: April 10, 2019
Accepted:
April 2,
2019
Received in revised form:
February 8,
2019
Received:
December 1,
2018
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
