Adrenal insufficiency in patients with cirrhosis, severe sepsis and septic shock

Ming Hung Tsai, Yun Shing Peng, Yung Chang Chen, Yu Pin Ho, Ji Tseng Fang, Jau Min Lien, Chun Yang, Pang Chi Chen, Cheng Shyong Wu

Research output: Contribution to journalArticlepeer-review

203 Citations (Scopus)

Abstract

Patients with cirrhosis are susceptible to bacterial infection, which can result in circulatory dysfunction, renal failure, hepatic encephalopathy, and a decreased survival rate. Severe sepsis is frequently associated with adrenal insufficiency, which may lead to hemodynamic instabity and a poor prognosis. We evaluated adrenal function using short corticotropin stimulation test (SST) in 101 critically ill patients with cirrhosis and severe sepsis. Adrenal insufficiency occurred in 51.48% of patients. The patients with adrenal insufficiency had a higher hospital mortality rate when compared with those with normal adrenal function (80.76% vs. 36.7%, P < .001). The cumulative rates of survival at 90 days were 15.3% and 63.2% for the adrenal insufficiency and normal adrenal function groups, respectively (P < .0001). The hospital survivors had a higher cortisol response to corticotropin (16.2 ± 8.0 vs. 8.5 ± 5.9 μg/dL, P < .001). The cortisol response to corticotropin was inversely correlated with various disease severity, Model for End-Stage Liver Disease, and Child-Pugh scores. Acute physiology, age, chronic health evaluation III score, and cortisol increment were independent factors to predict hospital mortality. Mean arterial pressure on the day of SST was lower in patients with adrenal insufficiency (60 ± 14 vs. 74.5 ± 13 mm Hg, P < .001 ), and a higher proportion of these patients required vasopressors (73% vs. 24.48%, P < .001). Mean arterial pressure, serum bilirubin, vasopressor dependency, and bacteremia were independent factors that predicted adrenal insufficiency. In conclusion, adrenal insufficiency is common in critically ill patients with cirrhosis and severe sepsis. It is related to functional liver reserve and disease severity and is associated with hemodynamic instability, renal dysfunction, and increased mortality.

Original languageEnglish
Pages (from-to)673-681
Number of pages9
JournalHepatology
Volume43
Issue number4
DOIs
Publication statusPublished - Apr 2006
Externally publishedYes

ASJC Scopus subject areas

  • Hepatology

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