PSUN32 Critical Illness-Related Corticosteroid Insufficiency (CIRCI) Among Patients with COVID-19 at a Tertiary Hospital: Clinical Characteristics and Outcomes

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.