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

Jang, Jae Young; Kim, T. Y.; Sohn, Joo Hyun; Lee, T. H.; Jeong, Soung Won; Park, E. J.; Lee, S. H.; Kim, S. G.; Kim, Y. S.; Kim, H. S.; Kim, B. S.

doi:10.1111/apt.12891

Cited by 29 publications

(63 citation statements)

References 27 publications

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“…15,17,18 The CIRCI frequency of 20% identified in this study falls within the previously published range of similar studies. 13,14,[19][20][21] In line with previous study, 19 we found that CIRCI prevalence was tightly correlated with liver function as reflected by the CTP, MELD and AARC-ACLF scores. In addition, it was also dramatically elevated in ACLF patients at mid and late stages, compared to those at early stage.…”

Section: Discussionsupporting

confidence: 90%

Prognostic Factors Related to the Mortality Rate of Acute-on-Chronic Liver Failure Patients

Zhang¹,

Li²,

Chen³

et al. 2021

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Background: Critical illness-related corticosteroid insufficiency (CIRCI) is known to be a common complication in patients with acute-on-chronic liver failure (ACLF). However, factors that predict the survival rate of ACLF patients remain unclear. The present study aims to determine the prognostic factors that impinge on the survival rate of ACLF patients. Methods: A total of 90 patients with ACLF at different stages, with or without CIRCI, were prospectively evaluated. Results: Various clinical factors were found to be significantly different among patients at early, mid and late stages of ACLF, as well as between the same population of patients with and without CIRCI. Specifically, patients at later stages of ACLF and patients with CIRCI had significantly higher Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD) and ACLF Research Consortium (AARC)-ACLF scores. CIRCI was observed in 20% of the enrolled patients (18 out of 90). In addition, the 90-day mortality rate was higher in mid-and late-stage ACLF patients, as well as patients with CIRCI. Conclusion: ACLF stage and CIRCI predict early mortality in patients with ACLF and could be actively monitored in these patients for prioritized liver transplantation.

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Section: Discussionsupporting

confidence: 90%

Prognostic Factors Related to the Mortality Rate of Acute-on-Chronic Liver Failure Patients

Zhang¹,

Li²,

Chen³

et al. 2021

DMSO

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“…436 RAI has also been described in patients with cirrhosis and, although it is mainly present in critically ill patients with sepsis or septic shock (68.9%), it also affects non-critically ill cirrhotic patients (41.8%), including those with compensated cirrhosis. [437][438][439][440][441][442] The pathophysiology of RAI in cirrhosis is not well defined. Suppression of the hypothalamic-pituitaryadrenal axis activity, reduced effective volemia, which may impair adrenal perfusion, and both impaired cholesterol synthesis and enhanced pro-inflammatory cytokine production likely contribute to impair adrenal steroidogenesis.…”

Section: Relative Adrenal Insufficiencymentioning

confidence: 99%

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

Angeli¹,

Bernardi

Villanueva³

et al. 2018

Journal of Hepatology

2,046

1,750

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The natural history of cirrhosis is characterised by an asymptomatic compensated phase followed by a decompensated phase, marked by the development of overt clinical signs, the most frequent of which are ascites, bleeding, encephalopathy, and jaundice. The following Clinical Practice Guidelines (CPGs) represent the first CPGs on the management of decompensated cirrhosis. In this context, the panel of experts, having emphasised the importance of initiating aetiologic treatment for any degree of hepatic disease at the earliest possible stage, extended its work to all the complications of cirrhosis, which had not been covered by the European Association for the Study of the Liver guidelines, namely: ascites, refractory ascites, hyponatremia, gastrointestinal bleeding, bacterial infections, acute kidney injury, hepatorenal syndrome, acute-on-chronic liver failure, relative adrenal failure, cirrhotic cardiomyopathy, hepatopulmonary syndrome, and porto-pulmonary hypertension. The panel of experts, produced these GPGs using evidence from PubMed and Cochrane database searches providing up to date guidance on the management of decompensated cirrhosis with the only purpose of improving clinical practice.

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“…They showed that AI prevalence in cirrhosis was 24%, and no AI in patients were found with chronic hepatitis. [ 18 ]…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and prevalence of adrenal insufficiency in hemodynamically stable patients with cirrhosis

et al. 2018

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It is well known that adrenal insufficiency is common in septic shock or hemodynamically unstable patients. But, there is as yet no sufficient clinically significant data about the exact prevalence or differences in the cause of cirrhosis with adrenal insufficiency. To investigate adrenal insufficiency prevalence in hemodynamically stable patients with cirrhosis and determine differences based on cirrhosis severity or etiology.From July 2011 to December 2012, 69 hemodynamically stable patients with cirrhosis without infection admitted at Hallym University Medical Center were enrolled. Adrenal insufficiency was defined as a peak cortisol level < 18 μg/dL, 30 or 60 minutes after 250 μg Synacthen injection.The study included 55 male patients (79.7%), and the mean age was 57.9 ± 12.9 years. Cirrhosis etiology was alcohol consumption, HBV, HCV, both viral and alcohol related, and cryptogenic in 49, 15, 7, 11, 9 patients, respectively. Adrenal insufficiency occurred in 24 patients (34.8%). No differences were found in age, sex, mean arterial pressure, heart rate, HDL, cirrhosis etiology, degree of alcohol consumption, encephalopathy, variceal bleeding history, or hepatocellular carcinoma between patients with or without adrenal insufficiency. Serum albumin level was lower (P < .05), and INR was higher (P < .05) in patients with than in those without adrenal insufficiency. However, multivariate analysis revealed no independent adrenal insufficiency predictor. Significant negative correlations were found between Child–Pugh score and peak cortisol levels (γ=−0.365, P = .008).Adrenal insufficiency was frequent even in hemodynamically stable patients with cirrhosis and tended to be associated with only liver disease severity, being unrelated to cirrhosis etiology.

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

Abstract: SUMMARY BackgroundThe relationship between relative adrenal insufficiency (RAI) and chronic liver disease is unclear.

Cited by 29 publications

References 27 publications

Prognostic Factors Related to the Mortality Rate of Acute-on-Chronic Liver Failure Patients

Prognostic Factors Related to the Mortality Rate of Acute-on-Chronic Liver Failure Patients

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

Clinical characteristics and prevalence of adrenal insufficiency in hemodynamically stable patients with cirrhosis

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