Abstract
Introduction: Relative adrenal insufficiency is a feature of liver dysfunction where adrenal cortex cannot synthesize enough cortisol at times of pathological stress and which may not manifest during normal periods.
Aim: To assess the prevalence of Relative Adrenal Insufficiency (RAI) in stable cirrhotic ascites and its relationship with further occurrence of infective and non-infective complications.
Methodology: In this prospective study, out of all cirrhotic patients presenting with ascites to our department, those with SBP, HRS, jaundice, sepsis, ARDS, previous steroid use, other complications/ comorbidities were excluded at the time of admission and 60 patients were selected. In these patients LDSST was done and RAI was diagnosed on the basis of low post stimulation cortisol and low delta cortisol. These 60 patients were divided into two cohorts, those with RAI and those without RAI and followed up over a period of 6 months for the development of infective (SBP, HRS, Sepsis) and non-infective complications (encephalopathy, coagulopathy, jaundice, bleeding ) to know whether the two groups had any significant difference in the occurrence of these complications.
Results: Infective complications like SBP (63 %;p value 0.018),HRS(55.6 %;p value 0.017), Sepsis (44 %,p value 0.046) were significantly increased in RAI group. With respect to non-infective complications and other infections there were no significant differences.
Conclusion: In those patients with RAI selective interventions like corticosteroids or albumin could be tried to prevent infective complications.
Keywords: RAI-Relative Adrenal Insufficiency, SBP – spontaneous bacterial peritonitis, HRS- hepatorenal syndrome.
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Corresponding Author
Anvin Thomas
Institute of Medical Gastroenterology, Madras Medical College, The Tamil Nadu Dr. M.G.R Medical University, Chennai, India
DOI: https://dx.doi.org/10.18535/jmscr/v8i10.45
