Association of adrenal insufficiency with patient-oriented health-care outcomes in adult medical inpatients

OBJECTIVE Adrenal insufficiency in the outpatient setting is associated with excess morbidity, mortality, and impaired quality of life. Evidence on its health-care burden in medical inpatients is scarce. The aim of this study was to assess the health-care burden of primary (PAI) and secondary adrenal insufficiency (SAI) among hospitalized inpatients. DESIGN and METHODS In this nationwide cohort study, adult medical patients with either PAI or SAI hospitalized between 2011 and 2015 were compared with propensity-matched (1:1) medical controls, respectively. The primary outcome was 30-day all-cause in-hospital mortality. Main secondary outcomes included ICU admission rate, length-of-hospital stay, 30-day- and 1-year all-cause readmission rates. RESULTS In total, 594 hospitalized cases with PAI and 4`880 with SAI were included. Compared with matched controls, in-hospital mortality was not increased among PAI or SAI patients, respectively. Patients with adrenal insufficiency were more likely to be admitted to ICU (PAI: OR 1.9 [95%CI, 1.27 to 2.72], and SAI: OR 1.5 [95%CI, 1.35 to 1.75]). Length of hospital stay was prolonged by 1.0 days in PAI patients (8.9 vs. 7.9 days [95%CI, 0.06 to 1.93]), and by 3.3 days in SAI patients (12.1 vs. 8.8 days [95%CI, 2.82 to 3.71]), when compared to matched controls. Patients with SAI were found to have higher 30-day and 1-year readmission rates (14.1% vs. 12.1% and 50.0% vs.40.7%; p<0.001) than matched controls. CONCLUSIONS While no difference in in-hospital mortality was found, adrenal insufficiency was associated with prolonged length of hospital stay, and substantially higher rates of ICU admission and hospital readmission.