009) and serum sodium (131 ± 7 versus 135 ± 5 mEq/L, P = 0.007) and higher blood urea nitrogen (32 ± 24 versus 24 ± 15 mg/dl, P = 0.06), plasma

renin activity (7.1 ± 9.9 versus 3.4 ± 5.6 ng/mL*h, P = 0.03), and noradrenaline concentration (544 ± 334 versus 402 ± 316 pg/mL, P = 0.02). During follow-up, patients with RAI exhibited a higher probability of infection (41% versus 21%, P = 0.008), severe sepsis (27% versus 9%, P = 0.003), type-1 hepatorenal syndrome (HRS) (16% versus 3%, P = 0.002), and death (22% versus 7%, P = 0.01). Conclusion: RAI is frequent in noncritically ill patients with acute decompensation of cirrhosis. As compared with those with normal adrenal function, patients with RAI have greater impairment of circulatory and renal function, higher probability of severe sepsis and type-1 HRS, and higher short-term mortality. (Hepatology 2013;58:1757–1765) Relative adrenal insufficiency (RAI) Selleck Bioactive Compound Library is a syndrome characterized by an inadequate production of cortisol with respect to peripheral demands.[1, 2] It was first described and has been mainly studied in critically ill patients (severe sepsis, septic shock, head injury, pancreatitis,

burns, and major surgery) who require high circulating cortisol levels to modulate systemic inflammatory response, maintain the vascular tone and permeability, and adapt metabolism to stress.[1-7] During the last decade evidence has been presented that RAI may also be an important feature in patients with cirrhosis.[8-22]

The first studies on RAI in critically ill patients with cirrhosis were published IWR-1 cell line between 2003 and 2008 and included mainly patients with decompensated cirrhosis and severe sepsis or septic shock. These studies showed a very high prevalence of RAI (51%-77%) and a clear association with poor liver function, renal failure, filipin refractory shock, and hospital mortality.[8-11] Two recent studies confirm the high prevalence of RAI in patients with cirrhosis and septic shock (76%)[12] or gastrointestinal hemorrhage (60%).[13] Recent but limited data suggest that RAI can also occur in noncritically ill cirrhosis patients.[14-22] The reported prevalence of this entity, which is now refer to as “hepatoadrenal syndrome,”[9, 22] ranges in the different studies between 7% and 49%, depending on the methodology used for RAI diagnosis.[15-22] However, there are no data on the relationship between RAI and clinical course of noncritically ill cirrhosis patients. This article reports the results of a prospective study evaluating adrenal function in a large series of patients admitted to the hospital for the treatment of acute decompensation of cirrhosis. Patients were followed for 3 months. The aim of the study was to assess if RAI is associated with differences in the natural course of the disease and survival.