BACKGROUND Adrenal insufficiency (AI) in hospitalized patients is a fatal condition if left undiagnosed. Most patients may require an adrenocorticotropic hormone (ACTH) stimulation test to facilitate AI diagnosis. We aim to identify simple biochemical and clinical factors and derive a predictive model to help identify hospitalized patients with biochemical AI who have indeterminate 0800 h serum cortisol levels. METHODS A seven-year retrospective study was performed in a tertiary care medical center. We identified 128 inpatients who had undergone low-dose or high-dose ACTH stimulation tests. The association between biochemical AI and other factors was evaluated using a logistic regression model clustering by ACTH dose. Stepwise regression analysis was used to demonstrate the predictive model. Diagnostic performance was evaluated using ROC analysis. RESULTS Of the 128 patients, 28.1% had biochemical AI. The factors associated with biochemical AI were serum random cortisol < 10 μg/dL (OR = 8.69, p < 0.001), cholesterol < 150 mg/dL (OR = 2.64, p = 0.003), sodium < 140 mmol/L (OR = 1.73, p = 0.004)). Among clinical factors, cirrhosis (OR = 9.05, p < 0.001), Cushingoid appearance in those with exogenous steroid use (OR = 8.56, p < 0.001), and chronic kidney disease (OR = 2.21, p < 0.001) were significantly linked to biochemical AI. The AUC-ROC of the final model incorporating all factors was 83%. CONCLUSIONS These easy-to-perform biochemical tests and easy-to-assess clinical factors could help predict biochemical AI in hospitalized patients with high accuracy. The physician should therefore have a high index of suspicion to perform dynamic tests for AI diagnosis in those who meet the proposed model criteria.

中文翻译：

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临床和生化因素预测皮质醇水平不确定的住院患者的生化肾上腺功能不全：一项回顾性研究。

背景技术如果不加以诊断，住院患者的肾上腺功能不全（AI）是致命的疾病。大多数患者可能需要促肾上腺皮质激素（ACTH）刺激测试以促进AI诊断。我们旨在确定简单的生化和临床因素，并建立预测模型，以帮助确定住院生化AI不确定的0800小时血清皮质醇水平的患者。方法在三级医疗中心进行为期七年的回顾性研究。我们确定了接受低剂量或高剂量ACTH刺激试验的128位住院患者。生化AI和其他因素之间的关联是通过ACTH剂量的Logistic回归模型聚类评估的。逐步回归分析用于证明预测模型。使用ROC分析评估诊断性能。结果在128例患者中，有28.1％患有生化性AI。与生化AI相关的因素包括血清随机皮质醇<10μg/ dL（OR = 8.69，p <0.001），胆固醇<150 mg / dL（OR = 2.64，p = 0.003），钠<140 mmol / L（OR = 1.73，p = 0.004））。在临床因素中，肝硬化（OR = 9.05，p <0.001），外源性类固醇使用者的库欣类外观（OR = 8.56，p <0.001）和慢性肾脏疾病（OR = 2.21，p <0.001）与以下因素显着相关生化AI。纳入所有因素的最终模型的AUC-ROC为83％。结论这些易于执行的生化测试和易于评估的临床因素可以帮助准确预测住院患者的生化AI。