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2017, Number 4

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Ann Hepatol 2017; 16 (4)

Relative Adrenal Insufficiency is Associated with the Clinical Outcome in Patients with Stable Decompensated Cirrhosis

Cholongitas E, Goulis I, Pagkalidou E, Haidich AB, Karagiannis AKA, Nakouti T, Pipili C, Oikonomou T, Gerou S, Akriviadis E

Language: English
References: 20
Page: 584-590
PDF size: 160.18 Kb.


ABSTRACT

Background. The clinical impact of relative adrenal insufficiency (AI) on patients with stable decompensated cirrhosis (DeCi) has not been yet elucidated. Aim. Explore the association between AI and outcome [death or liver transplantation (LT)] in patients with DeCi. Material and methods. Patients with DeCi presenting no active complication have been included. Clinical and laboratory data, including serum levels of corticosteroid-binding globulin (CBG), interleukin (IL)-1b, IL-6 and tumor necrosis factor (TNFα) were recorded in each participant. Salivary cortisol (SC) and serum total cortisol (STC) were assessed at (T0) and 1 h (T60) after intravenous injection of 250 µg corticotropin. Results. 113 consecutive patients were totally tested. Median SC was 3.9 ng/mL and 15.5 ng/mL and median STC was 10.7 µg/dL and 22.7 µg/dL at T0 and T60 respectively. The patients with AI [group 1, n = 34 (30%)] had significantly lower systolic blood pressure (106 ± 12 vs. 113 ± 13 mmHg, p = 0.05), serum sodium (133 ± 7 vs. 137 ± 12 mEq/ L, p = 0.04), HDL (29.9 ± 14 vs. 38.6 ± 18 mg/dL, p = 0.034) and albumin (2.7 ± 0.5 ±s. 3.1 ± 0.5 g/dL, p = 0.002), but higher direct bilirubin (median: 1.6 vs. 0.8 mg/dL, p = 0.029) compared to those without AI [group 2, n = 79 (70%)]. Moreover, group 1 patients presented more frequently past history of spontaneous bacterial peritonitis (SBP) [10/34 (29.4%) vs. 6/79 (7.5%), p = 0.002]. AI was significantly associated with death [HR = 2.65, 95% C.I.: 1.55 - 4.52, p = 0.003 over a follow up period of 12 (6-48) months.] Conclusions. The presence of AI in patients with stable DeCi predispose to obvious clinical implications since it is associated with circulatory dysfunction, previous history of SBP and worse survival.


REFERENCES

  1. Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet 2014; 383: 1749-61.

  2. Karagiannis AK, Nakouti T, Pipili C, Cholongitas E. Adrenal insufficiency in patients with decompensated cirrhosis. World J Hepatol 2015; 7: 1112-24.

  3. Peterson RE. Adrenocortical steroid metabolism and adrenal cortical function in liver disease. J Clin Invest 1960; 39: 320-31.

  4. Arabi YM, Aljumah A, Dabbagh O, Tamim HM, Rishu AH, Al- Abdulkareem A, Knawy BA, et al. Low-dose hydrocortisone in patients with cirrhosis and septic shock: a randomized controlled trial. CMAJ 2010; 182: 1971-7.

  5. Thevenot T, Borot S, Remy-Martin A, Sapin R, Cervoni JP, Richou C, Vanlemmens C, et al. Assessment of adrenal function in cirrhotic patients using concentration of serum-free and salivary cortisol. Liver Int 2011; 31: 425-33.

  6. Trifan A, Chiriac S, Stanciu C. Update on adrenal insufficiency in patients with liver cirrhosis. World J Gastroenterol 2013; 19: 445-56.

  7. Acevedo J, Fernández J, Prado V, Silva A, Castro M, Pavesi M, Roca D, et al. Relative adrenal insufficiency in decompensated cirrhosis: Relationship to short-term risk of severe sepsis, hepatorenal syndrome, and death. Hepatology 2013; 58: 1757-65.

  8. Tan T, Chang L, Woodward A, McWhinney B, Galligan J, Macdonald GA, Cohen J, et al. Characterising adrenal function using directly measured plasma free cortisol in stable severe liver disease. J Hepatol 2010; 53: 841-8.

  9. Fede G, Spadaro L, Tomaselli T, Privitera G, Scicali R, Vasianopoulou P, Thalassinos E, et al. Comparison of total cortisol, free cortisol, and surrogate markers of free cortisol in diagnosis of adrenal insufficiency in patients with stable cirrhosis. Clin Gastroenterol Hepatol 2014; 12: 504-12.

  10. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461-70.

  11. Fleming JS, Nunan TO. The new BNMS guidelines for measurement of glomerular filtration rate. Nucl Med Commun 2004; 25: 755-7.

  12. Kazankov K, Holland-Fischer P, Andersen NH, Torp P, Sloth E, Aagaard NK, Vilstrup H. Resting myocardial dysfunction in cirrhosis quantified by tissue Doppler imaging. Liver Int 2011; 31: 534-40.

  13. Fede G, Spadaro L, Tomaselli T, Privitera G, Germani G, Tsochatzis E, Thomas M, et al. Adrenocortical dysfunction in liver disease: a systematic review. Hepatology 2012; 55: 1282-91.

  14. Galbois A, Rudler M, Massard J, Fulla Y, Bennani A, Bonnefont- Rousselot D, Thibault V, et al. Assessment of adrenal function in cirrhotic patients: salivary cortisol should be preferred. J Hepatol 2010; 52: 839-45.

  15. Marik PE. Adrenal-exhaustion syndrome in patients with liver disease. Intensive Care Med 2006; 32: 275-80.

  16. Bornstein SR. Predisposing factors for adrenal insufficiency. N Engl J Med 2009; 360: 2328-39.

  17. Theocharidou E, Krag A, Bendtsen F, Moller S, Burroughs AK. Cardiac dysfunction in cirrhosis - does adrenal function play a role? A hypothesis. Liver Int 2012; 32: 1327-32.

  18. Kharb S, Garg MK, Puri P, Nandi B, Brar KS, Gundgurthi A, Pandit A. Assessment of adrenal function in liver diseases. Indian J Endocrinol Metab 2013; 17: 465-71.

  19. Fede G, Spadaro L, Tomaselli T, Privitera G, Piro S, Rabuazzo AM, Sigalas A, et al. Assessment of adrenocortical reserve in stable patients with cirrhosis. J Hepatol 2011; 54: 243-50.

  20. Acevedo J, Fernandez J. New determinants of prognosis in bacterial infections in cirrhosis. World J Gastroenterol 2014; 20: 7252-9.




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