title: Adrenal insufficiency in patients with cirrhosis and septic shock: Effect of treatment with hydrocortisone on survival.
abstract: Relative adrenal insufficiency is frequent in patients with severe sepsis and is associated with hemodynamic instability, renal failure, and increased mortality. This study prospectively evaluated the effects of steroids on shock resolution and hospital survival in a series of 25 consecutive patients with cirrhosis and septic shock (group 1). Adrenal function was evaluated by the short corticotropin test within the first 24 hours of admission. Patients with adrenal insufficiency were treated with stress doses of intravenous hydrocortisone (50 mg/6 h). Data were compared to those obtained from the last 50 consecutive patients with cirrhosis and septic shock admitted to the same intensive care unit in whom adrenal function was not investigated and who did not receive treatment with steroids (group 2). Incidence of adrenal insufficiency in group 1 was 68% (17 patients). Adrenal dysfunction was frequent in patients with advanced cirrhosis (Child C: 76% vs. Child B: 25%, P = .08). Resolution of septic shock (96% vs. 58%, P = .001), survival in the intensive care unit (68% vs. 38%, P = .03), and hospital survival (64% vs. 32%, P = .003) were significantly higher in group 1. The main causes of death in group 1 were hepatorenal syndrome or liver failure (7 of 9 patients). In contrast, refractory shock caused most of the deaths in group 2 (20 of 34 patients). In conclusion, 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.
authors.affiliation: Liver Unit, Department of Surgery and Centro de Investigaciones Biomédicas Esther Koplowitz, IMDiM, IDIBAPS, Hospital Clínic, University of Barcelona, Spain. jfdez@clinic.ub.es
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández
authors.forename: Angels
authors.initials: A
authors.lastname: Escorsell
authors.forename: Michel
authors.initials: M
authors.lastname: Zabalza
authors.forename: Vanessa
authors.initials: V
authors.lastname: Felipe
authors.forename: Miguel
authors.initials: M
authors.lastname: Navasa
authors.forename: Antoni
authors.initials: A
authors.lastname: Mas
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Lacy
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
mesh_terms: D000309:Adrenal Insufficiency / Q000150:complications / Q000188:drug therapy*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015897:Comorbidity; D006530:Hepatorenal Syndrome / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000627:therapeutic use*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D017093:Liver Failure / Q000401:mortality; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D012772:Shock, Septic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D012709:Serum Albumin; D006854:Hydrocortisone