Hyperacute adrenal insufficiency after hemorrhagic shock exists and is associated with poor outcomes

BACKGROUND Adrenal insufficiency (AI) has been extensively described in sepsis but not in acute hemorrhage. We sought to determine the incidence of hyperacute AI (HAI) immediately after hemorrhage and its association with mortality. METHODS Patients with acute traumatic hemorrhagic shock presenting to the R Adams Cowley Shock Trauma Center prospectively had serum cortisol levels collected on admission. Inclusion criteria were hypotension and active hemorrhage. Clinicians were blinded to results, and no patient received steroids in the acute phase. The primary outcome measure was death from hemorrhage within 24 hours of admission. RESULTS Fifty-nine patients were enrolled during an 8-month period. Mean admission cortisol level was 18.3 ± 8.9 μg/dL. Acute mortality rate from hemorrhage was 27%. Overall mortality rate was 37%. Severe HAI (serum cortisol level