Relative adrenal insufficiency in chronic liver disease: its prevalence and effects on long-term mortality.
Aliment Pharmacol Ther
; 40(7): 819-26, 2014 Oct.
Article
em En
| MEDLINE
| ID: mdl-25078874
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.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Insuficiência Adrenal
/
Hepatite
/
Cirrose Hepática
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article