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Table 3 Predictors of a low response to adrenocorticotrophic hormone

From: Predicting a low cortisol response to adrenocorticotrophic hormone in the critically ill: a retrospective cohort study

Factor

Increase ≥250 nmol/l

(n = 170)

Increase <250 nmol/l

(n = 235)

P

OR

(95% CI)

Peak ≥500 nmol/l

(n = 276)

Peak <500 nmol/l

(n = 129)

P

OR

(95% CI)

Time from admission (days)a

5 (1–77)

3 (1–92)

<0.0001

 

4 (1–77)

4 (1–92)

  

Intubationa

161 (95)

229 (97)

  

261 (95)

129 (100)

0.004

na

   Time until test (days)a

4 (0–76)

2 (0–70)

0.001

 

3 (0–76)

3 (0–70)

  

Fluconazolea

12 (7)

29 (12)

0.077

1.85

(0.92–3.75)

22 (8)

19 (15)

0.050

2.00

(1.04–3.83)

   Time until test (days)

4 (0–15)

7 (0–63)

0.038

 

6 (0–63)

5 (0–53)

  

SAPS II*

35 (7–97)

44 (7–100)

<0.0001

 

39 (9–97)

40 (7–100)

  

SOFA*

8 (0–21)

10 (0–21)

<0.0001

 

8 (0–21)

10 (0–21)

0.014

 

Multiple organ dysfunctiona

103 (61)

194 (83)

<0.0001

3.08

(1.95–4.86)

192 (70)

105 (81)

0.016

1.92

(1.15–3.19)

Heart rate (beats/min)a

90 (48–146)

96 (59–171)

0.001

 

94 (48–171)

94 (52–146)

  

Vasopressors/inotropesa

134 (79)

206 (88)

0.020

1.91

(1.12–3.26)

226 (82)

114 (88)

  

Mechanical ventilationa

152 (89)

224 (95)

0.031

2.41

(1.11–5.25)

250 (91)

126 (98)

0.012

4.37

(1.30–14.71)

FiO2b

0.41 (0.29–1.0)

0.50 (0.34–1.0)

<0.0001

 

0.45 (0.29–1.0)

0.49 (0.30–1.0)

  

PaO2/FiO2b

240 (59–681)

203 (44–641)

0.005

 

220 (44–681)

225 (77–641)

  

Renal replacementa

23 (14)

47 (20)

  

35 (13)

35 (27)

0.001

2.56

(1.52–4.33)

Urine production (ml)a

255 (0–8845)

1667 (0–6970)

<0.0001

 

1989 (0–10140)

1697 (0–6970)

  

Creatinine (μmol/l)a

92 (23–695)

122 (20–1934)

<0.0001

 

112 (20–1934)

116 (36–675)

  

Urea (mmol/l)b

10.2 (0.7–46.3)

13.3 (1.5–149)

0.018

 

12.1 (1.0–149)

12.4 (0.7–89.8)

  

Glasgow Coma Scale scorea

15 (3–15)

11 (3–15)

0.070

 

11 (3–15)

15 (3–15)

  

Positive other local culturea

50 (29)

88 (37)

  

76 (28)

62 (48)

<0.0001

2.43

(1.58–3.76)

SIRSa

116 (68)

194 (83)

0.001

2.20

(1.38–3.51)

213 (77)

97 (75)

  

Sepsisa

80 (47)

138 (59)

0.021

1.60

(1.08–2.38)

147 (53)

71 (55)

  

Haemoglobin (mmol/l)a

5.8 (4.0–7.9)

5.7 (3.6–9.7)

  

5.8 (4.0–8.8)

5.6 (3.6–9.7)

0.011

 

Haematocrita

0.28 (0.20–0.38)

0.27 (0.17–0.44)

  

0.28 (0.20–0.43)

0.26 (0.17–0.44)

0.004

 

Platelets (× 109/l)a

192 (20–818)

130 (3–756)

<0.0001

 

173 (4–818)

123 (3–468)

0.001

 

Eosinophils (%)

1 (0–5)

0 (0–4)

0.014

 

0 (0–5)

0 (0–1)

  

Albumin (g/l)b

17 (6–32)

13 (3–34)

<0.0001

 

17 (3–34)

12 (3–32)

<0.0001

 

Bilirubin (μmol/l)c

10 (3–176)

14 (2–441)

0.001

 

12 (2–280)

12 (2–441)

  

Arterial pHa

7.43 (7.07–7.56)

7.38 (6.89–7.64)

<0.0001

 

7.41 (6.89–7.64)

7.39 (7.02–7.54)

0.039

 

Bicarbonate (mmol/l)a

25.0 (6.6–37.8)

21.7 (6.8–37.0)

<0.0001

 

23.8 (6.6–37.8)

21.9 (12.1–33.4)

0.005

 

Glucose (mmol/l)a

7.6 (1.9–35.0)

7.1 (2.3–25.8)

0.036

 

7.3 (2.6–35.0)

7.1 (1.9–25.8)

  
  1. Values are expressed as median (range) or number (%), where appropriate. Exact P values are given where P < 0.10. aData available in >95%. bData available in ≥75%. cData available in 64%. 500 nmol/l = 18 μg/dl cortisol. CI, confidence interval; FiO2, inspired fractional oxygen; HR, heart rate; na, not applicable; PaO2, partial arterial oxygen tension; SAPS, Simplified Acute Physiology Score; SIRS, systemic inflammatory response syndrome; SOFA, Sequential Organ Failure Assessment.