Endocrine Abstracts

Background: Patients with adrenal insufficiency suffer from increased morbidity and mortality. Quantitative evidence on the health-care burden of either primary (PAI) or secondary adrenal insufficiency (SAI) among hospitalized medical patients is scarce.

Methods: In this observational cohort study, we analysed nationwide acute care hospitalizations from patients with PAI or SAI, respectively, between 2011 and 2015 using prospective administrative data. Patients with either PAI or SAI were compared with propensity score-matched (1:1) controls, based on age, gender, citizenship, hospital volume, year of admission, Charlson Comorbidity Index, and relevant medical diagnoses. The primary outcome was in-hospital mortality. Secondary outcomes were intensive care unit (ICU) admission, intubation rate, length of hospital stay, and 30-day-readmission.

Results: We included 594 patients with PAI and 4880 patients with SAI. Compared with matched controls, in-hospital mortality was comparable among patients with PAI (odds ratio (OR) 1.12 (95% CI 0.65 to 1.95)) and SAI (OR 1.14 (95% CI 0.88 to 1.24)), respectively. Patients with adrenal insufficiency were more likely to be admitted to the ICU (PAI: OR 2.56 (95% CI 1.69 to 3.90), and SAI: OR 3.03 (95% CI 2.60 to 3.54)). The risk for intubation was 3-fold higher in SAI patients (OR 3.04 (95% CI 2.40 to 3.84)), whereas there was a trend in PAI patients (OR 1.77 (95% CI 0.93 to 3.37)). The mean length of hospital stay was 1.8 days longer in PAI patients (8.9 vs. 7.1 days; difference 1.83 (95% CI 0.81 to 2.86)) and 4.6 days longer in SAI patients (12.1 vs. 7.5 days; difference 4.62 (95% CI 4.20 to 5.04)). The risk for 30-day hospital readmissions was increased in SAI patients (OR 1.48 (95% CI 1.33 to 1.64)) but not in PAI patients (OR 1.34 (95% CI 0.93 to 1.93)).

Conclusion: Among medical inpatients, adrenal insufficiency was associated with significant health-care burden, leading to higher rates of ICU admission, intubation and prolonged length of hospital stay. Whether these compromised outcomes can be improved by a more comprehensive diagnostic and therapeutic work-up needs to be addressed in clinical Trials.