Relative Adrenal Insufficiency is Associated with the Clinical Outcome in Patients with Stable Decompensated Cirrhosis

Goulis, Ioannis; Pagkalidou, Eirini; Haidich, Anna Bettina; Karagiannis, A.; Nakouti, Theodora; Pipili, Chrysoula; Oikonomou, Theodora; Gerou, Spyridon; Akriviadis, Evangelos

doi:10.5604/01.3001.0010.0298

Cited by 11 publications

(38 citation statements)

References 20 publications

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“…445 This explains why RAI in decompensated cirrhosis is associated with a higher probability of severe sepsis and type-1 HRS, and higher short-term mortality. 437,446…”

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

1,954

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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“…445 This explains why RAI in decompensated cirrhosis is associated with a higher probability of severe sepsis and type-1 HRS, and higher short-term mortality. 437,446…”

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

1,954

1,750

View full text Add to dashboard Cite

show abstract

“…Bacterial infections, in general, represent a particular threat in patients with decompensated cirrhosis, as they can be associated with a significant systemic inflammatory response leading to considerable hemodynamic changes. Patients with decompensated cirrhosis are characterized by a high vulnerability to these hemodynamic disturbances due to the presence of portal hypertension, which can be further complicated by cirrhotic cardiomyopathy and/or adrenal insufficiency [20–22]. However, severity of systemic inflammation as well as the effects on portal hypertension may be influenced by the type of infection.…”

Section: Discussionmentioning

confidence: 99%

Sustained impact of nosocomial-acquired spontaneous bacterial peritonitis in different stages of decompensated liver cirrhosis

et al. 2019

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Background & aims Bacterial infections, in particular a spontaneous bacterial peritonitis (SBP), are a major threat in patients with liver cirrhosis. Recently, it has been shown that the impact on mortality might be underestimated by established risk-scores. Onset of infection was suggested to define a distinct stage of cirrhosis. However, it remains unclear whether all stages of decompensated cirrhosis are equally affected. Moreover, if there is such a distinct stage, it must be determined whether it is reversible after the infection has resolved. In this study we aimed to further analyze the impact of a current as well as a resolved SBP in different stages of decompensated liver cirrhosis. Methods A number of 579 patients with liver cirrhosis and ascites were included. MELD-score was used to determine the stage of liver disease. Low (<15), intermediate (15–25) and high (>25) MELD-groups were compared. Patients were followed up for 90 days. Primary endpoint was overall mortality. Statistical analyses were performed using the log-rank test, Cox regression and competing risk analysis. Results Mortality was significantly higher in patients with nosocomial-acquired SBP (nSBP) compared to patients without SBP (p<0.001;HR = 2.05). However, the most prominent difference in mortality was documented in the intermediate MELD-group (nSBP: p = 0.02;HR = 2.10). Importantly, mortality in nSBP patients remained increased even after the initial nSBP episode had resolved (p<0.01;HR = 1.90). Again, this was only significant in those with intermediate MELD-scores (p = 0.02;HR = 2.28). While a current as well as a resolved nSBP were significantly linked to a higher mortality, neither of them did increase the likelihood for liver transplantation. Conclusions Development of nSBP is independently associated with increased mortality supporting the concept of a distinct status of cirrhosis. Importantly, the prognosis remains unfavorable even after resolution of nSBP. This could be particularly relevant for patients with intermediate MELD-scores, who have limited chances for a donor liver.

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“…Of note, adrenal insufficiency contributes to cardiomyopathy in cirrhosis patients via the downregulation of β-adrenergic receptors as well as the alteration of catecholamines’ effects on the systemic vascular tone[31]. Furthermore, the presence of adrenal insufficiency in patients with stable decompensated cirrhosis is associated with poorer clinical characteristics, such as circulatory dysfunction, previous history of SBP, and worse survival rate[32].…”

Section: The Paradigm Shifts In the Definition And Pathophysiology Ofmentioning

confidence: 99%

Acute kidney injury spectrum in patients with chronic liver disease: Where do we stand?

Chancharoenthana

Leelahavanichkul

2019

WJG

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Acute kidney injury (AKI) is a common complication of liver cirrhosis and is of the utmost clinical and prognostic relevance. Patients with cirrhosis, especially decompensated cirrhosis, are more prone to develop AKI than those without cirrhosis. The hepatorenal syndrome type of AKI (HRS–AKI), a spectrum of disorders in prerenal chronic liver disease, and acute tubular necrosis (ATN) are the two most common causes of AKI in patients with chronic liver disease and cirrhosis. Differentiating these conditions is essential due to the differences in treatment. Prerenal AKI, a more benign disorder, responds well to plasma volume expansion, while ATN requires more specific renal support and is associated with substantial mortality. HRS–AKI is a facet of these two conditions, which are characterized by a dysregulation of the immune response. Recently, there has been progress in better defining this clinical entity, and studies have begun to address optimal care. The present review synopsizes the current diagnostic criteria, pathophysiology, and treatment modalities of HRS–AKI and as well as AKI in other chronic liver diseases (non-HRS–AKI) so that early recognition of HRS–AKI and the appropriate management can be established.

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Relative Adrenal Insufficiency is Associated with the Clinical Outcome in Patients with Stable Decompensated Cirrhosis

Cited by 11 publications

References 20 publications

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

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

Sustained impact of nosocomial-acquired spontaneous bacterial peritonitis in different stages of decompensated liver cirrhosis

Acute kidney injury spectrum in patients with chronic liver disease: Where do we stand?

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