Critical Illness-related Corticosteroid Insufficiency is Common in Covid-19 and Treatment Provide Survival Benefit

Purpose: Covid-19 is a severe lethal disease characterized with pneumonia and acute respiratory distress syndrome. We aimed to analyze the prevalence of critical illness-related corticosteroid insufficiency (CIRCI) in Covid-19 patients treated in intensive care unit and whether treatment of it would create any survival benefit. Methods: A total of 119 Covid-19 patients in intensive care unit were enrolled into the study. All patients received treatment for Covid-19 according to national guideline including hydroxychloroquine, favipiravir, antibiotics including azithromycin and oseltamivir in some patients. Basal cortisol below 10 µg/dl were accepted as CIRCI and above 34 µg/dl as intact HPA axis. Patients between them were introduced 1 µg cosynthropin stimulation test and delta cortisol below 9 µg/dl were also accepted as CIRCI. All patients who got diagnosis received hydrocortisone 300 mg/day until clinical condition stabilized. Mortality rate was recorded, then. Results: CIRCI was detected in 50.4% of cases and mean plasma ACTH level was 14.8±6.0 pg/ml. Patients below age 65 had a statistically higher risk (63.4 % vs. 40.2%, p=0.012). Presence of comorbidity did not increase the risk of CIRCI (47.3% vs. 62.5%, p=0.18). Also, severity of pulmonary involvement and intubation did not increase the risk of CIRCI. Total mortality rate was 49.5% and not different in patients with and without CIRCI (45.0% vs. 54.5%, p=0.31) indicating benefit of corticosteroid treatment. Conclusion: CIRCI is common in Covid-19 patients treated in intensive care unit and treatment of CIRCI provide survival benefit.