ODP065 Impact of Comorbid Adrenal Insufficiency on Outcomes During Hospitalization For Cardiogenic Shock

Abstract Background The catabolic stress associated with cardiogenic shock requires a robust metabolic, neuroendocrine, and immunologic response to mitigate, and adrenocortical hormones play a huge role in this process. On the other hand, excessive aldosterone production is known to play a key part in the long-term progression of myocardial insufficiency through myocyte remodeling. It is thus intriguing to understand how adrenocortical insufficiency impacts the outcomes of patients admitted for cardiogenic shock. Method: A retrospective cohort study was designed using data obtained from the 2016 to 2018 combined National Inpatient Sample (NIS) database. Adult patients (age >18) with principal admission diagnosis of cardiogenic shock were identified using the international diseases classification code, tenth revision (ICD 10), and separated into two cohorts based on the presence of a secondary diagnosis of adrenal insufficiency. Primary outcomes assessed were, mortality, length of stay (LOS) and total hospital charge. Secondary outcomes evaluated included rate of mechanical ventilation, mechanical circulatory support device use and cardiac arrest. Multivariate linear and logistic regressions were used to adjust for confounders. Results There was a total of 477,695 adult hospitalizations for cardiogenic shock, out of which 1.28% had associated secondary diagnosis of adrenal insufficiency. There was a statistically insignificant increased odds of mortality among patients with adrenal insufficiency (33.42% vs 33.35%, AOR: 1. 05, 95% CI: 0.93 to 1.19, p: 0.462). There was also an increased length of stay (18.91 days vs 11.35 days, adjusted mean difference: 6.5 days, 95%CI: 5.22 days to 7.78 days, p < 0. 001) and an increased total charge (364,864.5 vs 238,591.9 USD, adjusted mean difference: 105,491.9 USD, 95%CI: 78,252.2USD to 132,731.3 USD, p < 0. 001) among patients with adrenal insufficiency compared with the counterpart cohort group and these were statistically significant. Patients with adrenal insufficiency also had 42% increased odds of being mechanically ventilated during cardiogenic shock admission compared to patients without (55.67% vs 46.61%, AOR: 1.42, 95%CI: 1.26 to 1.60, p < 0. 001). Other secondary clinical outcomes assessed, including mechanical circulatory support devices use and cardiac arrest were not statistically different between the two groups. Conclusion Adrenal insufficiency as a comorbid diagnosis among patients admitted with cardiogenic shock was associated with increased odds of requiring mechanical ventilation, prolonged length of stay and higher total hospital charges. There was a trend towards increased mortality, but this was not statistically significant. There was no difference in other clinical outcomes including mechanical circulatory support devices and cardiac arrest rate. Presentation: No date and time listed