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Master Thesis

Critical Illness - Related Corticosteroïd Insufficiency after Non-severe Acute Aneurysmal Subarachnoid Haemorrhage : impact on complications and early outcome

Abstract : Introduction: Aneurysmal subarachnoid haemorrhage (ASAH) is a life threatening condition that may be aggravated by hormonal disturbances such as critical illness-related corticosteroid insufficiency (CIRCI). Our study aimed to assess the incidence of CIRCI in acute non-severe SAH and seek a connection with the occurrence of complications and functional outcome. Materials and methods: Patients with non-severe SAH (WFNS grade ≤3) were included. Hormonal assays were collected in the first 48 hours: baseline and stimulated cortisol (after 250 µg of Synacthene®) and ACTH. CIRCI was defined by a random total cortisol of < 100 ng/ml or a ∆ cortisol of < 90 ng/ml. Patients were followed for 30 days with identification of complications: vasospasm, delayed cerebral ischemia, rebleeding, seizure, hydrocephalus and infection. After 30 days, Glasgow outcome scale (GOS), modified Rankin scale (mRS) and the Short Form-12 (SF-12) were assessed by phone conversation. Results: 52 patients were included from June 2013 to March 2016. The incidence of CIRCI was 17.3% in the acute phase. The overall complications incidence was 78% in the CIRCI patients versus 44% in the none CIRCI patients but there was no correlation between CIRCI and the occurrence of complications except infections. CIRCI was not statistically associated with a less favourable outcome. Conclusion: The present results support earlier findings that CIRCI occurs frequently after ASAH. Furthermore, we have demonstrated that CIRCI was not associated with a higher rate of complication neither less favorable outcome at 1 month.
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https://dumas.ccsd.cnrs.fr/dumas-02145919
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Submitted on : Monday, June 3, 2019 - 2:15:57 PM
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Baptiste Ollivier. Critical Illness - Related Corticosteroïd Insufficiency after Non-severe Acute Aneurysmal Subarachnoid Haemorrhage : impact on complications and early outcome. Life Sciences [q-bio]. 2018. ⟨dumas-02145919⟩

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