Relative adrenal insufficiency in decompensated cirrhosis. relationship to short-term risk of severe sepsis, hepatorenal syndrome and death.
Hepatology. 2013 May 31;
Authors: Acevedo J, Fernández J, Prado V, Silva A, Castro M, Pavesi M, Roca D, Jimenez W, Ginès P, Arroyo V
BACKGROUND: The prevalence of relative adrenal insufficiency (RAI) in critically ill cirrhotic patients with severe sepsis is over 60% and associated features include poor liver function, renal failure, refractory shock and high mortality. RAI may also develop in non-critically ill cirrhotic patients but its relationship to clinical course has not yet been assessed. The current study was performed in 143 non-critically ill cirrhotic patients admitted for acute decompensation. METHODS: Within 24h after hospitalization adrenal function, plasma renin activity, plasma noradrenaline and vasopressin concentration, and serum levels of nitric oxide, IL-6 and TNF-α were determined. RAI was defined as a serum total cortisol increase <9 μg/dL after 250 μg of intravenous corticotropin from basal values <35 μg/dL. Patients were followed-up during 3 months. RESULTS: RAI was detected in 26% of patients (n=37). At baseline, patients with RAI presented lower mean arterial pressure (76±12 vs. 83±14 mmHg, p=0.009) and serum sodium (131±7 vs. 135±5 mEq/L, p=0.007) and higher BUN (32±24 vs. 24±15 mg/dl, p=0.06), plasma renin activity (7.1±9.9 vs. 3.4±5.6 ng/mL*h, p=0.03) and noradrenaline concentration (544±334 vs. 402±316 pg/ml, p=0.02). During follow-up patients with RAI presented a higher probability of infection (41% vs. 21%, p=0.008), severe sepsis (27% vs. 9%, p=0.003), type-1 HRS (16% vs. 3%, p=0.002) and death (22% vs. 7%, p=0.01). CONCLUSIONS: RAI is frequent in non-critically ill patients with acute decompensation of cirrhosis. As compared with those with normal adrenal function, patients with RAI present greater impairment of circulatory and renal function, higher probability of severe sepsis and type-1 HRS and higher short-term mortality. (HEPATOLOGY 2013.).
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