Relative adrenal insufficiency in chronic liver disease: its prevalence and effects on long‐term mortality. Issue 7 (30th July 2014)

• Record Type: Journal Article
• Authors: Jang, J. Y.; Kim, T. Y.; Sohn, J. H.; Lee, T. H.; Jeong, S. W.; Park, E. J.; Lee, S. H.; Kim, S. G.; Kim, Y. S.; Kim, H. S.; Kim, B. S.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 40:Issue 7(2014)
• Page Start: 819
• Page End: 826
• Publication Date: 2014-07-30
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12891
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12891-abs-0001"> <title>Summary</title> <sec id="apt12891-sec-0001" sec-type="section"> <title>Background</title> <p>The relationship between relative adrenal insufficiency (RAI) and chronic liver disease is unclear.</p> </sec> <sec id="apt12891-sec-0002" sec-type="section"> <title>Aim</title> <p>To determine the frequency with which RAI is observed in noncritically ill patients at various stages of chronic liver disease, and the correlation between RAI and disease severity and long‐term mortality.</p> </sec> <sec id="apt12891-sec-0003" sec-type="section"> <title>Methods</title> <p>In total, 71 non‐critically ill patients with liver cirrhosis (<italic>n </italic>=<italic> </italic>54) and chronic hepatitis (<italic>n </italic>=<italic> </italic>17) were evaluated prospectively. A short stimulation test (SST) with 250 μg of corticotrophin was performed to detect RAI. RAI was defined as an increase in serum cortisol of <9 μg/dL in patients with a basal total cortisol of <35 μg/dL.</p> </sec> <sec id="apt12891-sec-0004" sec-type="section"> <title>Results</title> <p>RAI was observed in only 13 (24.1%) of 54 patients with cirrhosis. Compared to those without RAI, cirrhotic patients with RAI had significantly higher Child‐Turcotte‐Pugh score (10.3 ± 1.7 vs. 7.1 ± 1.8, mean ± s.d., <italic>P </italic><<italic> </italic>0.001) and Model for End‐Stage Liver Disease score (14.5 ± 6.6 vs. 9.4 ± 3.7, <italic>P </italic>=<italic> </italic>0.017). The cortisol response to corticotropin was negatively correlated with the severity of cirrhosis (<italic>P </italic><<italic> </italic>0.05). In addition, the mortality rate was higher in cirrhotic patients with RAI (69.2%) than in those without RAI (4.9%; <italic>P </italic><<italic> </italic>0.001) during the follow‐up period of 20.1 ± 13.5 months (range, 5.8–51.1 months). The cumulative 1‐year survival rates in cirrhotic patients with and without RAI were 69.2% and 95.0%, respectively (<italic>P </italic>=<italic> </italic>0.05), while the corresponding cumulative 3‐year survival rates were 0% and 95.0% (<italic>P </italic><<italic> </italic>0.001).</p> </sec> <sec id="apt12891-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Relative adrenal insufficiency is more commonly observed in those with severe cirrhosis, and is clearly associated with more advanced liver disease and a shortened long‐term survival. This suggests that relative adrenal insufficiency is an independent prognostic factor in non‐critically ill patients with cirrhosis.</p> </sec> </abstract>