Relative adrenal insufficiency in chronic liver disease: its prevalence and effects on long-term mortality.

Abstract

BACKGROUND:

The relationship between relative adrenal insufficiency (RAI) and chronic liver disease is unclear.

AIM:

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.

METHODS:

In total, 71 non-critically ill patients with liver cirrhosis (n = 54) and chronic hepatitis (n = 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.

RESULTS:

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., P < 0.001) and Model for End-Stage Liver Disease score (14.5 ± 6.6 vs. 9.4 ± 3.7, P = 0.017). The cortisol response to corticotropin was negatively correlated with the severity of cirrhosis (P < 0.05). In addition, the mortality rate was higher in cirrhotic patients with RAI (69.2%) than in those without RAI (4.9%; P < 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 (P = 0.05), while the corresponding cumulative 3-year survival rates were 0% and 95.0% (P < 0.001).

CONCLUSIONS:

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.

• Authors: J Y Jang, T Y Kim, J H Sohn, T H Lee, S W Jeong, E J Park, S H Lee, S G Kim, Y S Kim, H S Kim, B S Kim
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 40 Issue 7 Pg. 819-26 (Oct 2014) ISSN: 1365-2036 [Electronic] England
• PMID: 25078874 (Publication Type: Journal Article)
• Copyright: © 2014 John Wiley & Sons Ltd.

Chemical References

• Adrenocorticotropic Hormone
• Hydrocortisone

Topics

• Adrenal Insufficiency (complications, diagnosis, epidemiology)
• Adrenocorticotropic Hormone
• Adult
• Aged
• Female
• Hepatitis (complications, epidemiology)
• Humans
• Hydrocortisone (blood)
• Liver Cirrhosis (complications, epidemiology)
• Male
• Middle Aged
• Prevalence
• Survival Rate
• Young Adult