الفهرس 
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Abstract
Critically ill patients are at risk for the development of Critical Illness-Related Corticosteroid Insufficiency (CIRCI). This may present as hypotension, unresponsiveness to catecholamine infusions, and/or ventilator dependence. Such patients may benefit from administration of exogenous steroids to restore their hemodynamic stability. Critically ill patients who were on chronic steroid therapy prior to injury or illness may also require steroid supplementation.
Cortisol is vitally important to the maintenance of vascular tone, endothelial integrity, vascular permeability, and total body water distribution. It also potentiates the vasoconstrictor actions of both endogenous and exogenous catecholamines.
Appropriate activation of the hypothalamic-pituitary-adrenal (HPA) axis in the critically ill patient is essential to stress adaptation and maintenance of homeostasis. Common causes of adrenal insufficiency in the critical care setting include infection, systemic inflammation, previous glucocorticoid use, and sepsis. While the incidence of CIRCI in the critically ill has been under appreciated, the detrimental impact of such dysfunction is well recognized.
Diagnostic criteria for CIRCI in the critically ill are not well established, but evidence suggests that modifications from standard testing are warranted. Random serum cortisol levels, free cortisol, and delta cortisol (change in baseline cortisol at 60 minutes after ACTH stimulation using 250 mcg cosyntropin) are all ways to evaluate for CIRCI. Free cortisol level testing is not available at most hospitals. A majority of experts will agree that a random serum cortisol <10 mcg/dL is low and >34 mcg/dL is high. Controversy of how to interpret levels between 10 and 34 mcg/dL exists
The aim of this study is to estimate the prevalence of CIRCI among ICU patient in Assuit university hospital and its presentation and outcome.
Methodology: prospective study enrolled patient in ICU with APACHII score >25 , and excluded those diagnosed previously as RAI or on steroid therapy
The participants was had complete history, cause of admission, vital signs, APACHII and SOFA scores and different laboratory investigation
Result: 39 patients was enrolled in this study regarding mean age was 62.5 years. Females represent 53.8% of the study participants; the most participants had DM (35.9%), followed by HTN, CVD and CKD, COPD, cancer and addict. And Pneumonia was the most common site of infection (56.4%). There were statistical insignificant differences between both groups in age, gender, comorbidities and site of infection. The mean APACHII and SOFA scores were 35.1±5.7 and 9.7±2.2 respectively
The RAI prevalence was found in 17 patients (43.6%) The RAI group had significantly lower serum cortisol level 13.1±2.3 than normal group 30.9±14.6 (p<0.001).
APACH II, SOFA, and all parameters related to vital signs showed insignificant differences between study groups
laboratory finding ; there were statistical insignificant differences between the study groups in all measured parameters except in PT and INR which were significantly lower among RAI group than normal group, while PC was significantly higher among RAI group than normal group.
51.3% showed improvement and 48.7% died with statistical insignificant difference between study groups. AKI was lower among RAI group than no RAI group with statistical insignificant difference, Hospital stay was significantly lower among RAI group than No RAI group
Conclusion: In current study CIRCI prevalence was 43.6%, with significant difference between both groups regarding PT and INR which were significantly lower among RAI group than normal group, while PC was significantly higher among RAI group than normal group.
Mortality among participants was 48.7 % with statistical insignificant difference between study groups. AKI was lower among RAI group than no RAI group with statistical insignificant difference, Hospital stay was significantly lower among RAI group than No RAI group.