Association of adrenal insufficiency with patient-oriented health-care outcomes in adult medical inpatients

Abstract

Objective Adrenal insufficiency in the outpatient setting is associated with excess morbidity, mortality, and impaired quality of life. Evidence on its health-care burden in medical inpatients is scarce. The aim of this study was to assess the health-care burden of primary adrenal insufficiency (PAI) and secondary adrenal insufficiency (SAI) among hospitalized inpatients. Design and methods In this nationwide cohort study, adult medical patients with either PAI or SAI hospitalized between 2011 and 2015 were compared with propensity-matched (1:1) medical controls, respectively. The primary outcome was 30-day all-cause in-hospital mortality. Main secondary outcomes included ICU admission rate, length-of-hospital stay, 30-day and 1-year all-cause readmission rates. Results In total, 594 hospitalized cases with PAI and 4880 cases with SAI were included. Compared with matched controls, in-hospital mortality was not increased among PAI or SAI patients, respectively. Patients with adrenal insufficiency were more likely to be admitted to ICU (PAI: OR 1.9 (95% CI, 1.27 to 2.72) and SAI: OR 1.5 (95% CI, 1.35 to 1.75)). Length of hospital stay was prolonged by 1.0 days in PAI patients (8.9 vs 7.9 days (95% CI, 0.06 to 1.93)), and by 3.3 days in SAI patients (12.1 vs 8.8 days (95% CI, 2.82 to 3.71)), when compared with matched controls. Patients with SAI were found to have higher 30-day and 1-year readmission rates (14.1 vs 12.1% and 50.0 vs 40.7%; P < 0.001) than matched controls. Conclusions While no difference in in-hospital mortality was found, adrenal insufficiency was associated with prolonged length of hospital stay, and substantially higher rates of ICU admission and hospital readmission.

Burden of acromegaly in the United States: increased health services utilization, location of care, and costs of care

“…Patients with hypopituitarism and concurrent secondary adrenal insufficiency may be at a greater risk of developing episodes of adrenal crisis. This may prompt visits to the ED, which then subsequently drive up the ED costs [30]. However, we found that the ED costs for patients with acromegaly and hypopituitarism were not higher than for those without hypopituitarism.…”

COVID-19 and the pituitary

“…In patients with adrenal insufficiency mortality rate appears to be more than doubled as compared to normal population, mainly due to cardiovascular disease and infections [ 121 ], particularly respiratory, which can be serious and expose to increased risk of hospitalization [ 122 ] and ICU admission [ 123 ] due to altered immune responses with reduced cytotoxic function of NK cells [ 124 ]. Clearly, increase in hospital admissions for such patients could also depend on a greater awareness of the risk of adrenal crisis during an infection [ 125 , 126 ].…”

Predictors of 30‐day readmissions for adrenal insufficiency: A retrospective national database study

“…14 Higher rates of hypertension, renal insufficiency, COPD and cancer and higher CCIs were present in patients with AI in a previous retrospective study. 5 The higher prevalence of comorbid conditions in patients with AI has been attributed to long-term excessive glucocorticoid exposure. 4 Previous reports have stated that comorbidities are the most influential factor in determining the incidence of future adrenal crisis, which accounts for a quarter of hospital admissions in patients with AI.…”

“…Obesity and AI have been linked because long-term excesses of glucocorticoids in patients with adrenal insufficiency increase the risk of developing obesity. 5 Obesity and AI have also been associated through a POMC mutation. 19,20 POMC is a pro-peptide that is expressed in the immune system, skin, pituitary gland and hypothalamus.…”

“…One cohort database study found that patients with AI had higher rates of comorbidities and inpatient admissions than matched 1:1 controls, which were selected from the general population in the same insurance database using the greedy algorithm based on age, region, gender and insurance type 4 . Additionally, research has been published about patient‐oriented healthcare outcomes in hospitalized patients and found that AI was associated with longer hospital stay, higher rates of ICU admissions and higher rates of hospital readmission 5 . Despite the known increased rate of readmissions in AI patients, there is a paucity of objective data characterizing readmission hospitalizations, rates of readmission and most importantly the predictors for readmission.…”