October 18, 2019
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Adrenal insufficiency increases ICU admission, prolongs hospital stay

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Hospitalized adults with primary or secondary adrenal insufficiency are more likely to be admitted to the ICU, be readmitted at 30 days or 1 year, and have a longer overall length of stay when compared with controls, according to findings from a propensity score-matched study published in the European Journal of Endocrinology.

Alexander Kutz

“This population-based study investigating the health care burden of more than 5,000 hospitalized cases with adrenal insufficiency is one of the largest so far,” Alexander Kutz, MD, attending physician in the division of endocrinology, diabetes and metabolism at University Hospital Basel, Switzerland, told Endocrine Today. “We found that adrenal insufficiency still carries a clinically relevant health care burden, as mirrored by increased health care utilization, prolonged length of hospital stay and higher hospital readmission rates. Remarkably, we did not find an increased hospital mortality rate in our study.”

Kutz and colleagues analyzed data from adults with primary (n = 594) or secondary adrenal insufficiency (n = 4,880) hospitalized between 2011 and 2015, matched 1:1 with propensity-matched controls, using data from the Swiss Federal Statistical Office (mean age, 65 years). The primary outcome was 30-day all-cause, in-hospital mortality. Main secondary outcomes included ICU admission rate, length of hospital stay, 30-day and 1-year all-cause readmission rates.

Compared with matched controls, adults with primary or secondary adrenal insufficiency were no more likely to die while in hospital; however, patients with adrenal insufficiency were more likely to be admitted to the ICU, with ORs of 1.9 for those with primary adrenal insufficiency (95% CI, 1.27-2.72) and 1.5 for secondary adrenal insufficiency (95% CI, 1.35-1.75).

Hospital beds 
Hospitalized adults with primary or secondary adrenal insufficiency are more likely to be admitted to the ICU, be readmitted at 30 days or 1 year, and have a longer overall length of stay when compared with controls.
Source: Adobe Stock

Researchers also found that patients with primary and secondary adrenal insufficiency stayed in hospital on average 1 (P = .037) and 3.3 (P < .001) additional days, respectively, when compared with controls. There were no between-group differences for 30-day or 1-year all-cause hospital readmission among patients with primary adrenal insufficiency vs. controls; however, those with secondary adrenal insufficiency had a higher 30-day readmission rate vs. controls (14.1% vs. 12.1%; P < .001) and higher 1-year readmission rate (50% vs. 40.7%; P < .001) vs. controls.

“Whether our findings are due to higher demand of health care resources as mirrored by prolonged hospital stay and increased readmission rates or due to higher vulnerability of patients with adrenal insufficiency remains debatable,” Kutz said. “However, increased efforts are warranted to tackle these shortcomings of patient-oriented outcomes in this fragile patient population, and thus, physician awareness of adrenal insufficiency in the hospital setting should be improved continuously.”

Kutz said it would be useful to replicate the findings using different and more sophisticated resources, including information about clinical appearance, disease severity and laboratory parameters to expedite appropriate and immediate therapeutic measures. – by Regina Schaffer

For more information:

Alexander Kutz, MD, can be reached at the Division of Endocrinology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; email: kutz.alexander@gmail.com.

Disclosures: The authors report no relevant financial disclosures.