Critical illness-related corticosteroid insufficiency: What we know and what we don’t know

Rivas, Marcella; Sotello, David

doi:10.12746/swrccc.v7i31.595

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…Binary logistic regression analysis revealed that physicians in the southern and western regions were statistically less likely to possess knowledge of CIRCI compared to their counterparts in the central region. This lack of knowledge among physicians may be attributed to the absence of precise diagnostic criteria for identifying patients who do not exhibit an elevation in cortisol levels during acute illness [ 9 ]. It is important to note that the level of total cortisol does not accurately reflect steroid levels, as it is influenced by free cortisol and its interaction with cortisol receptors.…”

Section: Discussionmentioning

confidence: 99%

A Cross-Sectional Survey Study on the Diagnosis and Management of Critical Illness-Induced Corticosteroid Insufficiency in Saudi Arabia

Qutob,

Alaryni,

Alghamdi

et al. 2023

Cureus

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Background The presence of critical illness-induced corticosteroid insufficiency (CIRCI) is correlated with elevated concentrations of circulating biomarkers associated with inflammation and coagulation in multiple domains. The management of adrenal insufficiency remains a topic of ongoing debate and disagreement among endocrinologists and intensivists. This study aimed to assess the extent of understanding regarding CIRCI among endocrinologists and intensivists who are actively practicing in Saudi Arabia. Methods This is an online cross-sectional survey study that was conducted between June and August 2023 to assess knowledge of CIRCI among endocrinologists and intensivists working in Saudi Arabia. The questionnaire tool for this study was constructed based on a previous literature review. Binary logistic regression analysis was used to define factors that affect participants’ knowledge of CIRCI. Results A total of 76 physicians were involved in this study. Around 32.9% (n= 25) of the participants described CIRCI correctly as an impairment of the hypothalamic-pituitary axis during critical illness. Around 35.5% (n=27) of the participants identified that widespread use of corticosteroids in critically ill patients prompted the need to revisit the concept, diagnosis, and management of CIRCI, and a similar proportion of the participants (35.5%) (n=27) identified that the role of corticosteroids in the management of CIRCI in critically ill patients may be beneficial in selected cases. Around 42.1% (n=32) of the participants identified that CIRCI is specific to critically ill patients while AI can occur in any individual. Around 17.1% (n=13) of the participants confirmed that there is no task force agreement on whether corticosteroids should be used in adult patients with sepsis but without shock. The mean knowledge score of the study participants was 3.6 (sd: 2.2) out of 10, which demonstrates a weak level of knowledge of CIRCI (36.0%). Binary logistic regression analysis identified that physicians from the southern and western regions were less likely to be knowledgeable of CIRCI compared to physicians from the central region (p< 0.05). Conclusion The study revealed that the level of familiarity with CIRCI among endocrinologists and intensivists in Saudi Arabia fell short of the desired benchmark. Clinicians may opt to utilize delta cortisol levels following cosyntropin administration and random plasma cortisol levels as diagnostic measures for CIRCI, instead of relying on plasma-free cortisol or salivary cortisol levels in conjunction with plasma total cortisol. Adherence to customized treatment protocols is crucial to attain the most favorable results for patients.

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Section: Discussionmentioning

confidence: 99%

A Cross-Sectional Survey Study on the Diagnosis and Management of Critical Illness-Induced Corticosteroid Insufficiency in Saudi Arabia

Qutob,

Alaryni,

Alghamdi

et al. 2023

Cureus

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“…Patients afflicted with CIRCI usually present with refractory hypotension which may also be accompanied by hypoglycemia, electrolyte abnormalities, metabolic acidosis, and eosinophilia. 7 The incidence of CIRCI can be as high as 60% in patients with septic shock. 8 Analysis of different cohorts shows that the incidence of CIRCI among patients with sepsis ranged from 12% to as high as 75%.…”

Section: Introductionmentioning

confidence: 99%

Critical Illness-Related Corticosteroid Insufficiency (CIRCI) among Patients with COVID-19 at a Tertiary Hospital: Clinical Characteristics and Outcomes

Arcellana

Lim

Arcegono

et al. 2023

JAFES

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Objectives. Among critically ill patients, there is usually impairment of the hypothalamic-pituitary-adrenal axis, leading to a condition known as critical illness-related corticosteroid insufficiency (CIRCI). This investigation aims to determine the incidence of and characterize CIRCI among patients with COVID-19 as well as to analyze the outcomes of these critically ill patients.Methodology. This is a single-center, retrospective cohort study that investigated the occurrence of CIRCI among critically ill patients infected with COVID-19.Results. In this cohort, there were 145 COVID-19-positive patients with refractory shock, which reflects that 22.94% of the COVID-19 admissions have probable CIRCI.Patients who were given corticosteroids were found to have statistically significant longer median days on a ventilator (p=0.001). However, those on the corticosteroid arm were at higher risk of morbidity and mortality and a greater proportion had organ dysfunction. Multivariable logistic regression analysis revealed that SOFA score was a significant predictor of mortality in CIRCI (p=0.013).Conclusion. CIRCI has a unique presentation among patients with COVID-19 because of the presence of a high level of inflammation in this life-threatening infection. It is possibly a harbinger of a markedly increased risk of mortality in these patients.

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“…Critical illness-related corticosteroid insufficiency or CIRCI, which refers to an inadequate and blunted corticosteroid response to the level of stress, is an underrecognized condition in the critical care arena. 1 It occurs in about 30-70% of critically ill patients 2 and can be as high as 77% in patients with sepsis. 3 The clinical presentation of CIRCI is ominous, commonly manifesting with shock refractory to fluid resuscitation and vasopressors.…”

Section: Introductionmentioning

confidence: 99%

The Development of a Protocol for Critical Illness-Related Corticosteroid Insufficiency (CIRCI) at a Tertiary Hospital

Arcellana¹,

Lim²,

Arcegono³

et al. 2022

JAFES

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Objectives The diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) remains a challenge. This initiative aimed to develop a protocol for the diagnosis and management of CIRCI which will facilitate informed decision-making among clinicians through consensus-building among a multi-disciplinary team. Methodology This was a single-center, qualitative study which utilized the modified Delphi method, consisting of a sequential iterative process with two rounds of voting. A cut-off value of 70% was set as the threshold for reaching consensus. Results The protocol on the diagnosis and management of CIRCI was approved after two rounds of voting, with all the components reaching 83.3%-100% agreement. This protocol on CIRCI provided a framework for the clinical approach to refractory shock. It was advocated that all cases of probable CIRCI should immediately be started on hydrocortisone at 200 mg/day. The definitive diagnosis of CIRCI is established through a random serum cortisol <10 mcg/dL or increase in cortisol of <9 mcg/dL at 60 minutes after a 250 mcg ACTH stimulation test in patients with indeterminate random cortisol levels. Conclusion The presence of refractory shock unresponsive to fluid resuscitation and vasopressors should warrant the clinical suspicion for the existence of CIRCI and should trigger a cascade of management strategies.

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Critical illness-related corticosteroid insufficiency: What we know and what we don’t know

Cited by 3 publications

References 24 publications

A Cross-Sectional Survey Study on the Diagnosis and Management of Critical Illness-Induced Corticosteroid Insufficiency in Saudi Arabia

A Cross-Sectional Survey Study on the Diagnosis and Management of Critical Illness-Induced Corticosteroid Insufficiency in Saudi Arabia

Critical Illness-Related Corticosteroid Insufficiency (CIRCI) among Patients with COVID-19 at a Tertiary Hospital: Clinical Characteristics and Outcomes

The Development of a Protocol for Critical Illness-Related Corticosteroid Insufficiency (CIRCI) at a Tertiary Hospital

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