Hydrocortisone for Cirrhotic Patients with Septic Shock: Double-Blind Placebo-Controlled Randomized Trial.

Arabi, Yaseen M.; Jumah, Ammar; Dabbagh, Ousama; Tamim, Hani; Rishu, Asgar; Abdulkareem, Amal; Knawy, Bandar Al; Hajeer, Ali H.; Al-Tamimi, Waleed; Cherfan, Antoine

doi:10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a1561

Cited by 1 publication

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite these initial favorable hemodynamic effects, hydrocortisone therapy was not associated with a reduction in 28-day mortality but was associated with an increase in shock relapse and gastrointestinal bleeding. 16 Hence, all the existing observational studies and the single RCT show hemodynamic improvement with hydrocortisone therapy in cirrhotic patients with septic shock and RAI. However, the survival benefit is inconsistent.…”

Section: Low-dose Hydrocortisone Therapymentioning

confidence: 98%

“…Several studies have examined the prevalence of RAI in patients with liver disease 7,[11][12][13][14][15][16][17][18] and are summarized in Table 1. Although these studies vary in their designs and the case definition of RAI, several inferences can be made.…”

Section: Prevalencementioning

confidence: 99%

“…In a homogenous group of cirrhotic patients presenting with septic shock, we documented a RAI prevalence of 77%. 16 PATHOPHYSIOLOGY RAI has been attributed to abnormalities at different levels of the physiologic pathway starting with the hypothalamus and pituitary gland to the adrenal gland and the circulating hormones and ending by dysfunction at the cellular level ( Fig. 1).…”

Section: Prevalencementioning

confidence: 99%

“…11,[13][14][15][16][17][18] Several mechanisms may be responsible. Lipopolysaccharides and proinflammatory mediators have been implicated and it will be discussed later in the article.…”

Section: The Adrenal Glandsmentioning

confidence: 99%

See 3 more Smart Citations

Relative Adrenal Insufficiency in Patients With Chronic Liver Disease

Arabi

Al‐Dorzi

2010

Clinical Pulmonary Medicine

View full text Add to dashboard Cite

The objective of this overview is to examine the prevalence, pathophysiology, diagnosis, and treatment of relative adrenal insufficiency (RAI) in patients with chronic liver disease. Several studies have demonstrated a high prevalence of RAI in this population, especially with advanced liver disease and during critical illness. The mechanisms of RAI include dysfunction of the hypothalamic-pituitary-adrenal axis, changes in circulating hormones, and peripheral glucocorticoid resistance. These are due, at least in part, to the increased levels of proinflammatory cytokines and lipopolysaccharides observed in this population. There is continued controversy about the best diagnostic test for RAI, because of the limitations of the current case definitions. Only a few studies examined the effect of hydrocortisone therapy in patients with liver disease and showed improvement in hemodynamic abnormalities. However, the effect on survival was not consistent in these studies. Further research in this area is needed to identify the best diagnostic and therapeutic approach to this important entity.

show abstract

Section: Low-dose Hydrocortisone Therapymentioning

confidence: 98%

Section: Prevalencementioning

confidence: 99%

Section: Prevalencementioning

confidence: 99%

“…11,[13][14][15][16][17][18] Several mechanisms may be responsible. Lipopolysaccharides and proinflammatory mediators have been implicated and it will be discussed later in the article.…”

Section: The Adrenal Glandsmentioning

confidence: 99%

See 2 more Smart Citations