OR30-05 Impact Of Adrenal Insufficiency On Outcomes Among Patients Admitted With COVID-19
Authors: Krishnaraju Ellil , Deenadayalan Vaishali , Maharjan Suman , Ogar Ufeh Annabel , Olafimihan Ayobami Gbenga , Stroger John H 
Published: October 2023

Disclosure: E. Krishnaraju: None. V. Deenadayalan: None. S. Maharjan: None. U.A. Ogar: None. A.G. Olafimihan: None.

Background: Patients with adrenal insufficiency (AI) are more susceptible to infections including COVID-19 and are more likely to develop adverse complications from adrenal crisis. There is a paucity of data using a national sample size to demonstrate the effect of AI on the hospital course of patients admitted with COVID-19. In this study, we aim to compare the outcomes in patients admitted with COVID-19, with and without a secondary diagnosis of Adrenal insufficiency (AI). Methods: This is a retrospective study of the 2020 National Inpatient Sample (NIS) database, utilizing ICD-10 codes to identify patients admitted for COVID-19 with and without AI. The groups were compared for socio-demographic differences, medical comorbidities, inpatient mortality, length of stay (LOS), and total hospital charges (THC). Secondary outcomes included a diagnosis of shock, myocardial infarction (MI), deep venous thrombosis (DVT), Urinary Tract Infection (UTI), sepsis, and blood transfusion. Statistics were performed using t-test, univariate and multinomial logistic regression. Results: A total of 1,058,815 patients with COVID-19 were hospitalized, of which 4,170 (0.4%) had a secondary diagnosis of adrenal insufficiency. There was no significant difference between the average age between the two groups, however, the COVID-AI group had a higher proportion of females (51.44% females; P=0.016). This group also had a higher odds of having a Charlson comorbidity index of 5 or more (38.73% vs 27.79%, P&lt;0.001) and having concomitant comorbidities like congestive heart failure (20.38% vs 15.55%; P&lt;0.001), chronic kidney disease (24.7% vs 19.65%; P&lt;0.001), COPD (18.11% vs 14.69%; P=0.004), and anemia (32.85% vs 19.91%; P&lt;0.001) compared to group without AI. Most notably, COVID-AI patients had significantly higher odds of mortality (AOR 2.45, p&lt;0.001), and prolonged hospital stay (AOR 6.82 days, p&lt;0.001) after adjusting for confounders. Among the secondary outcomes, the COVID-AI group had significantly higher odds of having sepsis (AOR 4.14, p&lt;0.001), shock (AOR 4.40, p&lt;0.001), MI (AOR 2.11, p=0.001 ), AKI (AOR 1.84, p&lt;0.001), DVT (AOR 2.45, p&lt;0.001), need for intubation (AOR 3.42, p&lt;0.001), pressor use (AOR 3.57, p&lt;0.001 ), and blood transfusion (AOR 2.33, p&lt;0.001 ). Conclusion: Patients who are adrenal insufficient are routinely educated to increase their steroid replacement therapy during illness. Previous studies have shown AI patients who are adequately treated and trained display the same incidence of COVID-19 symptoms and disease severity as Non-AI patients. Our study has shown any patient with a history of AI have an overall higher odds of mortality, prolonged hospital stay, and complications requiring ICU admission such as shock, need for pressors, and intubation. Therefore, emphasis on COVID preventative measures is vital for this subset of patients.

Presentation: Sunday, June 18, 2023