WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

*Dr. Mohammed Abdulrahman Mahmood, Dr. Hassan Majeed Hameed, Dr. Toran Hamed Yashar

ABSTRACT

Background: Severe trauma is a leading cause of mortality and morbidity globally, placing a huge load on emergency and critical care systems. In response to severe damage, the body initiates a complicated neuroendocrine stress reactions to preserve hemodynamic stability, metabolic balance, and immunological control. Adrenocortical insufficiency might occur due to disruption of these reactions. Objectives: Is to identify clinical and laboratory predictors of adrenocortical insufficiency in severely injured patients at Al-Tuz General Hospital. Methods: The study is an observational, descriptive, prospective cross-sectional study. It was conducted between the 1st of March 2024 to the end of September 2025. All severely injured patients admitted to the emergency department or ICU at Tuz General Hospital in Salahiddin Governorate/Iraq during the study period were assessed for eligibility. The study included patients aged more than or equal to 18 years with severe trauma defined by an Injury Severity Score (ISS) ≥ 16. As well as those who admitted within 24 hours of injury and been hemodynamically unstable or requiring intensive monitoring. On the other hand, the study excluded patients with known history of adrenal insufficiency, chronic steroid therapy within the previous 3 months or patients with known pituitary or adrenal disease. Additionally, the study excluded pregnant patients and patients who died before hormonal assessment. Results: The study includes 40 patients severely injured, of them 10 patients had adrenocortical insufficiency matched according to gender with 30 patients without adrenocortical insufficiency. The mean age ± standard deviation of the study participants is 59.74 ± 7.64 days. Male: Female ratio was 1.22:1. Statistically significant difference between them regarding their mean age (P value <0.001), body temperature (P value < 0.001), mean arterial pressure (P value <0.001), development of sepsis (P value <0.001) and GCS (P value <0.001). Moreover, statistically significant difference between them regarding their urinary volume (P value <0.001), and serum sodium (P value < 0.001). Conclusion: The study found seven factors may contribute to ACI following severe injury: patients' age, body temperature, MAP, development of sepsis, abnormal GCS, urine volume, and serum sodium level. If these factors have been detected, frequent testing of plasma ACTH and cortisol levels is recommended in clinical settings.

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