Relative adrenal insufficiency is frequent in patients with severe sepsis and is associated with hemodynamic instability, renal failure, and increased mortality.
Dr Javier Fernández and colleagues from Spain prospectively evaluated the effects of steroids on shock resolution and hospital survival in cirrhosis.
The research team evaluated a series of 25 consecutive patients with cirrhosis and septic shock in Group 1.
Adrenal function was evaluated by the short corticotropin test within the first 24 hours of admission.
The researchers treated patients with adrenal insufficiency with stress doses of intravenous hydrocortisone at 50 mg every 6 hours.
Data were compared to Group 2, with 50 consecutive patients with cirrhosis and septic shock admitted to the same intensive care unit.
|Incidence of adrenal insufficiency in Group 1 was 68%|
In these patients, adrenal function was not investigated and did not receive treatment with steroids.
The research team found that the incidence of adrenal insufficiency in Group 1 was 68%.
Adrenal dysfunction was frequent in patients with advanced cirrhosis.
Resolution of septic shock, survival in the intensive care unit, and hospital survival were significantly higher in Group 1.
The team noted that the main causes of death in Group 1 were hepatorenal syndrome or liver failure.
In contrast, the researchers refractory shock caused most of the deaths in Group 2.
Dr Fernández's team, “Relative adrenal insufficiency is very frequent in patients with advanced cirrhosis and septic shock.”
“Hydrocortisone administration in these patients is associated with a high frequency of shock resolution and high survival rate.”