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

Evangelos Cholongitas1, Ioannis Goulis1, Eirini Pagkalidou2

  • 14th Department of Internal Medicine, Hippokration General Hospital, Medical School Aristotle University of Thessaloniki, Greece.

Annals of Hepatology
|June 15, 2017
PubMed

Insights

Relative adrenal insufficiency (AI) in patients with stable decompensated cirrhosis (DeCi) is linked to circulatory issues and a higher risk of death. This study highlights the clinical impact of AI on DeCi outcomes, emphasizing its association with worse survival.

Area of Science:

  • Endocrinology
  • Hepatology
  • Critical Care Medicine

Background:

  • The clinical significance of relative adrenal insufficiency (AI) in patients with stable decompensated cirrhosis (DeCi) remains unclear.
  • AI is a potential complication in liver disease, affecting hormonal balance and physiological responses.

Purpose of the Study:

  • To investigate the association between AI and patient outcomes, specifically death or liver transplantation (LT), in individuals with DeCi.
  • To identify clinical and laboratory factors associated with AI in this patient population.

Main Methods:

  • A cohort of 113 patients with stable DeCi and no active complications were assessed.
  • Salivary cortisol (SC) and serum total cortisol (STC) were measured at baseline and 1 hour post-corticotropin injection.
  • Clinical data, including blood pressure, serum electrolytes, lipids, albumin, bilirubin, and history of spontaneous bacterial peritonitis (SBP), were collected.

Main Results:

  • 30% of patients (n=34) were diagnosed with AI.
  • AI patients exhibited lower systolic blood pressure, serum sodium, HDL, and albumin, with higher direct bilirubin compared to non-AI patients.
  • A history of SBP was significantly more frequent in patients with AI (29.4% vs. 7.5%).
  • AI was independently associated with an increased risk of death (HR=2.65, p=0.003) over a median follow-up of 12 months.

Conclusions:

  • Relative adrenal insufficiency is prevalent in stable decompensated cirrhosis and is associated with significant clinical implications.
  • AI in DeCi patients correlates with circulatory dysfunction, a history of SBP, and poorer survival rates.
  • These findings underscore the importance of evaluating adrenal function in patients with DeCi to potentially improve patient management and prognosis.
Abstract

Keywords:
LiverMELD scoreSalivary cortisolSpontaneous bacterial peritonitis.SurvivalTotal cortisol

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