Prospective evaluation of infection-induced emergency department applications in patients diagnosed with copd and using steroids

Objective: Steroids, as described in guidelines, reduces incidence of attacks, duration of hospitalization and mortality in COPD patients. Our clinical observations show that steroid usage of the COPD patients is above the recommendation of the guidelines. The goal of our study is in COPD patients whom steroid usage is common whether there is a link between surrenal gland supression and frequent emergenceny medicine application due to steroid usage. We also aimed to investigate whether there is an increase in the frequency of infection and sepsis of patients and their effects on mortality. Materials and methods: Our study, which is a prospective cross-sectional clinical research, was conducted in Çukurova University Faculty of Medicine (ÇÜTF) with the approval of the Ethics Committee and the support of the Scientific Research Project unit. COPD patients who were admitted to the ÇÜTF Department of Emergency Medicine Adult Emergency Department with the complaint of shortness of breath were included in the study over 18 years of age between May 1, 2018 and October 1, 2019. Demographic, clinical and routine laboratory results, lactate clearance, CRP, procalcitonin, ACTH, cortisol levels, the number of admissions to the emergency service, hospitalization and duration, 1 month mortality of patiends were examined. Patients were evaluated whether they were on steroid treatment or whether they were given steroids in Emergecy room. Results: 41 (82.0%) of the 50 patients who were included in the study and whose data were complete were male. The mean age of the patients was 66.72 years (49-85 years old). Patients' complaints, physical examination findings, comorbidities, hospitalization and mortality data, ACTH, procalcitonin, lactate averages were similar among the groups who received and did not receive steroids in the emergency room. Sputum complaint (p = 0.005), HF comorbidity rate (p = 0.007), non-analgesic use (p = 0.033), respiratory rate (p = 0.049), ral (p = 0.049), roncus (p = 0.00), percent of neutrophils (p = 0.028), Hb (p = 0.011) and HCT (p = 0.018) averages were found to be statistically significantly higher in the patients who received steroid treatments in emergency room than those who did not. In the index application, the mean lymphocyte percentages of the patients who received steroid treatment in the last 3 month in the emergency room were found to be statistically significantly higher than the patients who did not receive steroid treatments.When the average of hemoglobin and hematocrit values of the patients who received steroid treatment in the emergency room was examined in the index application, it was observed that the users who used the steroids in the last 3 months were statistically higher than those who did not use steroids (p = 0.04 for Hb and p = 0.004 for HCT). When the average cortisol levels of the patients who received steroid treatment in the emergency department was examined in the index application, it was found that those who did not use steroids in the last three months were significantly higher cortizol values than those who used steroid in last 3 months. (p = 0.013). However, the average cortizol valuse of patients who received steroids on index application were lower than in those who did not take steroid treatments and who used steroids in the last 3 months. (p >0,05). Discussion and Conclusion: In our study, the incidence of sputum complaints, ral and rhoncus incidence, neutrophil percentages, hemoglobin and hematocrit values of steroid users were found to be statistically significantly higher than compared to non-steroid users. Cortisol and ACTH levels were low in steroid users, but there was no statistically significant difference. We think that surrenal supression related to steroid use in COPD patients may develep and patients should be followed in this respect. However, we think that further studies, which can be repeatedly sampled for cortisol and ACTH with more patients may reveal this situation more clearly. Keywords: ACTH, COPD, Cortisol, Steroid, Surrenal supression