CORTICORESISTANCE SYNDROME IN CRITICAL ILLNESS: A GIVEN OR A GUIDE TO ACTION?

The aim of the research. Development of an additional diagnostic criterion for the early detection of CIRCI accompanied by vascular insufficiency in critically ill patients using ECMO.

Materials and methods. A prospective cohort study was performed in the intensive care unit (29 patients on ECMO). Patients with CIRCI were divided into: Ia (with vascular insufficiency and hyponatremia) and Ib (vascular insufficiency without hyponatremia). Both groups were treated with hydrocortisone when vasopressor requirements were ≥0,2 mcg/kg/min. Corticoresistance index CRI = 536 (nmol/l) / patient’s total cortisol value (nmol/l).

Results. According to the results of a comparative analysis, in group Ia the CRI compared to group Ib on the day of initiation of ECMO was higher Me 2,2-1,2, p = 0,03; in the last day ECMO was lower – 0,2-0,8 p = 0,003. Patients in group Ia were older in age (Me 58 vs. 33 years). On the day of ECMO initiation, patients did not differ significantly on the SOFA. Mortality in group Ia is 90,9%, in group Ib – 50%, p <0,05.

Conclusions. A prognostically high risk of developing corticoresistance and high mortality was observed in patients of the older age group with vascular insufficiency and hyponatremia when connected to ECMO with a corticoresistance index ≥2,2. Patients in the older age group (Me 58 years old) need to be prescribed hydrocortisone before the development of hyponatremia, an increase in the corticoresistance index ≥ 2,2, and therefore, it is not recommended to focus on the need for vasopressors ≥0,2 mcg/kg/min.

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