Hyperreninemic hypoaldosteronism syndrome, plasma concentrations of interleukin-6 and outcome in critically ill patients with liver cirrhosis.
OBJECTIVE
To investigate the relation between the adrenal production of gluco- and mineralocorticoids, the inflammatory status and the outcome in critically ill patients with liver cirrhosis.


METHODS
Prospective descriptive study.


METHODS
Medical intensive care unit (ICU) in a university hospital.


METHODS
Fifty consecutive patients with liver cirrhosis.


METHODS
A corticotropin stimulation test within 12h following ICU admission. Plasma cortisol concentration was measured before and after the test. Renin and aldosterone concentrations, as well as interleukin-6 (IL-6) level to assess the pro-inflammatory status, were measured only before the test. Impaired adrenal function was defined as cortisol response to the test less than 9microg/dl. Hyperreninemic hypoaldosteronism syndrome was defined as basal renin over aldosterone ratio (RRA) higher than 2.


RESULTS
Forty-one (82%) patients had impaired adrenal function, and 26 patients (52%) presented with RRA > 2. Patients with RRA > 2 exhibited greater disease severity and organ dysfunction scores at baseline, higher levels of serum renin and IL-6, and a greater ICU mortality rate, but risk-adjusted mortality rates were not different between the two groups. Renin and IL-6 plasma concentrations were positively correlated. Finally, in a Cox regression analysis, independent predictors of 30-day mortality were hyperreninemic hypoaldosteronism syndrome, IL-6 higher than 400pg/ml and severe renal failure.


CONCLUSIONS
Adrenal dysfunction was common in critically ill cirrhotic patients. Hyperreninemic hypoaldosteronism syndrome was related to a greater pro-inflammatory status and degree of acute organ failure, and was independently associated with a worse prognosis.
du Cheyron
Damien
D
Service de Réanimation Médicale, CHU de Caen, Av côte de Nacre, 14033 Caen Cedex, France. ducheyron-d@chu-caen.fr
Bouchet
Bruno
B
Cauquelin
Brigitte
B
Guillotin
Damien
D
Ramakers
Michel
M
Daubin
Cédric
C
Ballet
Jean-Jacques
JJ
Charbonneau
Pierre
P
D000368:Aged; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D005938:Glucocorticoids / Q000096:biosynthesis; D006801:Humans; D006994:Hypoaldosteronism / Q000378:metabolism*; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000032:analysis* / Q000097:blood / Q000378:metabolism; D008103:Liver Cirrhosis / Q000276:immunology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008901:Mineralocorticoids / Q000096:biosynthesis; D011446:Prospective Studies; D012084:Renin-Angiotensin System; D013577:Syndrome
D005938:Glucocorticoids; D015850:Interleukin-6; D008901:Mineralocorticoids