Adrenal insufficiency in severe West Nile Virus infection

Abroug, Fekri; Ouanes-Besbes, Lamia; Ouanes, Islam; Nciri, Noureddine; Dachraoui, Fahmi; Najjar, Fadhel
October 2006
Intensive Care Medicine;Oct2006, Vol. 32 Issue 10, p1636
Academic Journal
journal article
Objective: To explore adrenal function in severe West Nile virus (WNV) infection.Design and Setting: Prospective interventional cohort study in a medical ICU of a teaching hospital.Patients: Ten consecutive patients (seven men, mean age 64+/-12years, mean SAPS II 26+/-6) with definite diagnosis of WNV related meningoencephalitis and variable proportion of organ/system failure. All patients had fever (mean body temperature 39+/-1 degrees C) and altered mental status (mean Glasgow Coma Score 11+/-2). Mean SOFA score was 9+/-2; eight patients had systemic inflammatory response syndrome, five septic shock, and six acute respiratory failure (usually from central origin) requiring mechanical ventilation.Interventions: A short corticotropin test was performed in each patient to assess the adrenal function.Measurements and Results: Cortisol response was defined as the difference between baseline and corticotropin-stimulated peak. Absolute adrenal insufficiency was defined by a baseline cortisol level below 15 microg/dl (415 nmol/l). Relative insufficiency was defined by a cortisol response of 9 microg/dl (250 nmol/l) or less. Relative adrenal insufficiency, defined by a corticotropin response below 9 microg/dl, was observed in seven while the remaining three had normal cortisol response; six out of these seven died in the ICU. All patients with normal adrenal function survived.Conclusion: Adrenal insufficiency is frequent in severe WNV infection and carries a poor outcome. In the absence of specific effective treatment, our data provide a rational to investigate a supplemental corticosteroid treatment in a controlled trial.


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