The absence of adrenal gland enlargement during septic shock predicts mortality: a computed tomography study of 239 patients.

BACKGROUND: : Assessment and management of septic shock associated adrenal function remain controversial. The aim of this study was to explore the prognostic value of adrenal gland volume in adults with septic shock.

METHODS: : A short cosyntropin test and determination of adrenal volume by computed tomography were performed within 48 h of shock in patients with septic shock (n = 184) and in 2 control groups: 40 ambulatory patients and 15 nonseptic critically ill patients. The primary endpoint was intensive care unit mortality.

RESULTS: : At intensive care unit discharge, 59 patients with septic shock died. Adrenal volume was 12.5 cm [95% CI, 11.3-13.3] and 8 cm [95% CI, 6.8-10.1] in the nonseptic group (P < 0.05 with both septic cohorts) and 7.2 cm [95%CI, 6.3-8.5] in the ambulatory patient group (P < 0.05 in patients with septic shock). In patients with septic shock, adrenal volume less than 10 cm was associated with higher 28-day mortality rates with an area under the receiver operating curve of 0.84 [95% CI, 0.78-0.89]. Adrenal volume above 10 cm was an independent predictor of intensive care unit survival (hazard ratio = 0.014; 95% CI [0.004-0.335]).

CONCLUSION: : A total adrenal gland volume less than 10 cm during septic shock was associated in univariate and multivariate analysis with mortality at day 28 in patients with septic shock. Whether adrenal gland volume can be a surrogate of adrenal gland function and used to guide hydrocortisone therapy in septic shock patients needs to be further investigated.