Susceptibility and characteristics of infections in patients with glucocorticoid excess or insufficiency: The ICARO tool

Abstract

ObjectiveRegistry data show that Cushing’s syndrome (CS) and adrenal insufficiency (AI) increase mortality rates associated with infectious diseases. Little information is available on susceptibility to infections, especially milder forms that do not require hospitalization or prescription drugs. This study aimed to investigate infectious diseases in patients with glucocorticoid disorders through the development of a specific tool.MethodsWe developed and administered the ICARO questionnaire addressing infectious events over a 12-month observation period to 1017 outpatients referred to four University Hospitals between 2018 and 2019. The ICARO questionnaire showed good test-retest reliability. The odds of infection were estimated after adjustment for potential confounders and collated into the ICARO score, reflecting the frequency and duration of infections.Results75 patients were diagnosed with hypercortisolism and 135 with hypocortisolism; 237 were excluded for uncontrolled disease. The remaining 570 served as controls. Compared to controls, hypercortisolism was associated with higher odds of respiratory (2.3) and urinary tract infections (4.1), mycoses (3.3) and flu (2.1). Subgroup analysis confirmed an increased risk of UTI (3.7) and flu (3.2) in mild hypercortisolism. Post-dexamethasone cortisol levels correlated with the ICARO score. Hypocortisolism also exhibited higher odds of mycoses (2.3), gastrointestinal (2.2) and urinary tract infections (2.5), independently of any glucocorticoid replacement dose.ConclusionsICARO is the first of its kind questionnaire developed to address susceptibility to infections in patients with glucocorticoid disorders and revealed the high prevalence and features of self-reported infections. ICARO could be a valuable tool for monitoring infections in various clinical settings.