Abstract :
Background & Aims: Bacterial infections are common complications in patients with liver cirrhosis and are associated with a high mortality. Standard treatment outcome is limited. The aim of this study was to determine whether or not early assessment of adrenal functions and treatment with hydrocortisone in patients with relative adrenal insufficiency with severe sepsis could improve survival.
Methods: Patients with liver cirrhosis and severe sepsis were randomly assigned to receive either early assessment of adrenal functions within 24 hours of admission (Group 1) or no early assessment (Group 2). Standard treatment of severe sepsis was given in both groups. Low dose hydrocortisone (50 mg IV every 6 hour) was prescribed in patients with relative adrenal insufficiency. The study end point was at day-28 of hospitalization.
Results: Thirty-nine patients were enrolled and were randomized in two groups. There were 20 patients in group 1 and 19 patients in group 2. The occurrence of relative adrenal insufficiency was 20% (4 of 20 patients).Ten patients in Group 1 (50%) and 8 patients in Group 2 (42%) died while under treatment. Four patients in Group 1 were treated with hydrocortisone. Hospital survival rates at days-28 were 50% and 57.9% in Group 1 and Group 2, respectively (p = 0.62). Complications of cirrhosis; refractory shock, hepatorenal syndrome, gastrointestinal bleeding, bacterial resistance, fungal infection, in both groups were comparable and without statistical significance.
Conclusion: In this study, the useful of adrenal assessment and hydrocortisone treatment did not increase survival rate. Further studies with larger sample size and proper tests for adrenal assessment are needed for confirmation.
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file/Thai-Journal-of-gastroenterology-vol-12-no-1-4464245.pdf