• Jong Eun Park, Gun Tak Lee, Jiyeong Lee, Young-Min Kim, Tae Gun Shin, Se Uk Lee, Taerim Kim, Hee Yoon, Won Chul Cha, and Sung Yeon Hwang.
• Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea.
• Am J Emerg Med. 2021 Aug 1; 46: 430-436.

ObjectiveWe aimed to describe the clinical manifestations of patients with sepsis who had the hollow adrenal gland sign (HAGS) during the acute phase of resuscitation and evaluated its value in predicting in-hospital mortality.MethodsWe performed a single-center, retrospective study of patients with sepsis who visited the emergency department (ED) from November 2015 to December 2018. The patients were categorized into the positive HAGS (pHAGS) and negative HAGS (nHAGS) groups, based on its presence in initial dual-phase contrast-enhanced abdominal computed tomography (CT). The primary outcome was in-hospital mortality. A multiple logistic regression model was developed to assess variables related to in-hospital mortality.ResultsIn all, 156 patients were included, and 36.5% (n = 57) was assigned to the pHAGS group. Both the maximal Sequential Organ Failure Assessment score within 24 h after ED arrival (10, interquartile range [IQR] 7-13 vs. 8, IQR 6-10, p < 0.01) and APACHE II score (24, IQR 20-31 vs. 20, IQR 17-25, p < 0.01) were significantly higher in the pHAGS than in the nHAGS group; the former group received significantly more interventions including vasopressors, renal replacement therapy, mechanical ventilation, and transfusions; in-hospital mortality was significantly higher in the former than in the latter group (29.8% vs. 10.1%, p < 0.01). pHAGS was an independent predictor of in-hospital mortality (adjusted odds ratio, 2.89; 95% confidence interval, 1.08-7.78; p = 0.04).ConclusionsPatients with sepsis who showed the HAGS had more severe illness than those who did not, and had an increased need for organ-supportive interventions. Presence of the HAGS was independently associated with in-hospital mortality.Copyright © 2020. Published by Elsevier Inc.

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