Abstract 13014: Cardiac Arrhythmias, Hypotension and Need for Vasopressors Following Admissions for Addisonian Crisis; an Analysis via the 2016-2020 National Inpatient Sample

Introduction: Addisonian crisis(AC) is a life-threatening complication secondary to acute adrenal insufficiency. Various cardiac arrhythmias and complications can be seen during such episodes. While fluids and glucocorticoid replacement therapies are the main steps in management, critically ill patients often also require vasopressors (VP) to maintain an adequate Mean Arterial Pressure.

Methods: We queried adults with AC from the 2016-2020 National Inpatient Sample. The incidence of several cardiac arrhythmias and cardiac events was estimated. The need for VP among hypotensive cases and their impact on mortality were also analyzed.

Results: There were 28430 adult cases of AC with a mean age was 55.59 years (SEM 0.106) and involved predominantly females (62.9% of all cases). Several cardiac arrhythmias were also reported, such as atrial fibrillation (12.6%), supraventricular tachycardia (1.7%), ventricular tachycardia (1.5%), ventricular fibrillation (1.8%), and atrial flutter (1.8%). A diagnosis of hypotension was also reported in 23.2% (6590 cases) of cases, while 16.7% (4755 cases) had hyperkalemia. Among patients with hypotension, 305 (4.6%) cases also needed VP. Higher use of VP in hypotensive cases was observed among Hispanics (vs. Whites, aOR 1.772, 95% CI 1.195-2.627), Males (aOR1.826, 95% CI 1.407-2.371, p<0.01), history of hypertension (aOR1.670, 95% CI 1.232-2.263, p<0.01), prior stroke (aOR 1.741, 95% CI 1.111-2.726, p=0.015), or cirrhosis (aOR 2.185, 95% CI 1.084-4.406, p=0.029). Hypotensive patients requiring the use of VP were older (mean age 62.10 vs. 55.53 years, p<0.01), and with a higher mean Charlson Comorbidity Index (CCI) score (mean score 4.44 vs. 2.97, p<0.01) than those not requiring VP. Overall, 18.0% of hypotensive patients using VP died (vs. 2.2% not requiring VP, aOR 4.950, 95% CI 2.974-8.238, p<0.01).

Conclusions: AC presents with multiple cardiac arrhythmias. VP use in hypotensive cases was more common in Hispanics, Males, patients with a history of hypertension, stroke, or cirrhosis. Hypotensive patients requiring VP were also sicker and had a higher mortality rate. Thus, AC management and diagnosis must be prompt to reduce the odds of mortality.