PSUN32 Critical Illness-Related Corticosteroid Insufficiency (CIRCI) Among Patients with COVID-19 at a Tertiary Hospital: Clinical Characteristics and Outcomes
Authors: Arcellana Anna Elvira , Lim Kenneth Wilson , Arcegono Marlon , Jimeno Cecilia 
Published: November 2022

Abstract

Introduction
A significant number of patients afflicted with COVID-19, a viral illness caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), present with refractory shock, hemodynamic instability, acute respiratory distress syndrome and other severe manifestations of infection, warranting intensive care. 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). Currently, the incidence of CIRCI among critically ill patients with COVID-19 is unknown. There is also a paucity of data on how CIRCI is likely a significant risk factor for poor clinical outcomes in COVID-19 infected patients. Addressing this knowledge gap will shape decision-making in the intensive care setting because CIRCI is a treatable condition, and intervention for CIRCI in the form of glucocorticoids, when utilized in the appropriate context, is potentially lifesaving.

Objectives
The aims of this investigation were to determine the occurrence of CIRCI among patients with COVID-19 as well as to analyze the clinical characteristics and outcomes of these critically ill patients.

Methodology
This was a single-center, retrospective, cohort study that investigated the occurrence of CIRCI among critically ill patients infected with COVID-19. A chart review among admitted patients was done.

Results
In this cohort, there were 145 COVID-19 patients included. The median age of the patients was at 63 years old and the study population comprised of 57.24% males. Septic shock was the top etiology of shock at 72.22% of the population. The median Sequential Organ Failure Assessment (SOFA) score was 13 which suggests that most of the patients included in the study had a very high mortality rate, 40-50% risk of death. There was a high rate of organ dysfunction.
For COVID-19 patients in refractory shock, there was a high rate of utilization of steroids at 70.83%. After corticosteroids were initiated, blood pressure improved in 70.45% of the patients. Patients who were given corticosteroids were found to have statistically significant longer median days on ventilator (p= 0.001). However, those on the corticosteroid arm were at higher risk of morbidity and mortality as signified by statistically significant higher APACHE II scores (p = 0.0233), MPM scores (p = 0.006), and a greater proportion of patients with acute kidney injury (p= 0.028), oliguria, (p= 0.020) and CNS dysfunction (p = 0.019).
Significant predictors of mortality in CIRCI are higher MPM and APACHE II scores and longer time to initiation of steroids.

Conclusion
There is a substantially high incidence of CIRCI among critically ill patients infected with COVID-19. CIRCI has a unique presentation among COVID-19 patients because of the presence of a high level of inflammation in this life-threatening infection. It is a harbinger of markedly increased risk of mortality in these patients.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.