Patients with cirrhosis are susceptible to bacterial infection.
This 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.
Dr Cheng-Shyong Wu and colleagues from Taiwan evaluated adrenal function using short corticotropin stimulation test.
The research team assessed 101 critically ill patients with cirrhosis and severe sepsis.
Adrenal insufficiency occurred in 52% of patients.
The patients with adrenal insufficiency had a higher hospital mortality rate when compared with those with normal adrenal function, at 81% vs 37%.
|Survival with adrenal insufficiency was 15% vs 63% with normal adrenal function
The team observed that the cumulative survival rates at 90 days were 15% and 63% for the adrenal insufficiency and normal adrenal function groups, respectively.
The team found that the hospital survivors had a higher cortisol response to corticotropin.
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.
The researchers noted that mean arterial pressure on the day of SST was lower in patients with adrenal insufficiency.
In addition, the team found a higher proportion of these patients required vasopressors.
Mean arterial pressure, serum bilirubin, vasopressor dependency, and bacteremia were independent factors that predicted adrenal insufficiency.
Dr Wu's team concluded, “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.”