Relative adrenal insufficiency in dogs with sepsis

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background: A syndrome of relative adrenal insufficiency has been identified in septic humans, and is associated with hypotension and death. Relative adrenal insufficiency is generally associated with basal serum cortisol concentration within or above the reference range and a blunted cortisol response to adrenocorticotropic hormone administration. It is unknown whether relative adrenal insufficiency occurs in septic dogs. Hypothesis: That relative adrenal insufficiency occurs in septic dogs, and that relative adrenal insufficiency is associated with hypotension and mortality. Animals: Thirty-three septic dogs admitted to a small animal intensive care unit. Methods: Dogs were included in the study if they had a known or suspected infectious disease and had systemic inflammatory response syndrome. Dogs were excluded if they had disease or medication history expected to affect the hypothalamic-pituitary-adrenal axis. Serum cortisol and endogenous plasma adrenocorticotropic hormone concentrations were measured before, and serum cortisol concentration measured 1 hour after, intramuscular administration of 250 μg of cosyntropin/dog. The change in cortisol concentration (Δ-cortisol) before and after cosyntropin administration was determined in each dog. Results: Hypotension was associated with lower Δ-cortisol values (OR 1.3; CI 1.0-1.9; P = .029). Δ-Cortisol cutoff of 3.0 μg/dL was most accurate for predicting hypotension, survival to discharge, and 28-day survival. The rate of death in dogs with Δ-cortisol ≤3 μg/dL was 4.1 times that of dogs with Δ-cortisol >3 μg/dL (RR 4.1; CI 1.5-12.3; P = .01). Conclusions and Clinical Relevance: Δ-cortisol ≤3 μg/dL after adrenocorticotropic hormone administration is associated with systemic hypotension and decreased survival in septic dogs.

Original languageEnglish (US)
Pages (from-to)226-231
Number of pages6
JournalJournal of Veterinary Internal Medicine
Volume21
Issue number2
DOIs
StatePublished - Mar 2007

Fingerprint

Adrenal Insufficiency
sepsis (infection)
cortisol
Hydrocortisone
Sepsis
Dogs
dogs
hypotension
Hypotension
cosyntropin
corticotropin
Adrenocorticotropic Hormone
Cosyntropin
Serum
Systemic Inflammatory Response Syndrome
Survival
Mortality
intramuscular injection
infectious diseases
drug therapy

Keywords

  • Canine
  • Critical illness-related corticosteroid insufficiency
  • Hypotension
  • Septic
  • Systemic inflammatory response syndrome

ASJC Scopus subject areas

  • veterinary(all)

Cite this

Relative adrenal insufficiency in dogs with sepsis. / Burkitt Creedon, Jamie; Haskins, Steve C.; Nelson, Richard W; Kass, Philip H.

In: Journal of Veterinary Internal Medicine, Vol. 21, No. 2, 03.2007, p. 226-231.

Research output: Contribution to journalArticle

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abstract = "Background: A syndrome of relative adrenal insufficiency has been identified in septic humans, and is associated with hypotension and death. Relative adrenal insufficiency is generally associated with basal serum cortisol concentration within or above the reference range and a blunted cortisol response to adrenocorticotropic hormone administration. It is unknown whether relative adrenal insufficiency occurs in septic dogs. Hypothesis: That relative adrenal insufficiency occurs in septic dogs, and that relative adrenal insufficiency is associated with hypotension and mortality. Animals: Thirty-three septic dogs admitted to a small animal intensive care unit. Methods: Dogs were included in the study if they had a known or suspected infectious disease and had systemic inflammatory response syndrome. Dogs were excluded if they had disease or medication history expected to affect the hypothalamic-pituitary-adrenal axis. Serum cortisol and endogenous plasma adrenocorticotropic hormone concentrations were measured before, and serum cortisol concentration measured 1 hour after, intramuscular administration of 250 μg of cosyntropin/dog. The change in cortisol concentration (Δ-cortisol) before and after cosyntropin administration was determined in each dog. Results: Hypotension was associated with lower Δ-cortisol values (OR 1.3; CI 1.0-1.9; P = .029). Δ-Cortisol cutoff of 3.0 μg/dL was most accurate for predicting hypotension, survival to discharge, and 28-day survival. The rate of death in dogs with Δ-cortisol ≤3 μg/dL was 4.1 times that of dogs with Δ-cortisol >3 μg/dL (RR 4.1; CI 1.5-12.3; P = .01). Conclusions and Clinical Relevance: Δ-cortisol ≤3 μg/dL after adrenocorticotropic hormone administration is associated with systemic hypotension and decreased survival in septic dogs.",
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