Table 1.
Prevalence of adrenal insufficiency in critically ill patients with liver cirrhosis
| Ref. | No. of patients (type of cirrhosis) | Diagnosis and definition of AI | Prevalence of AI |
| Harry et al[14] | 20 (ALF/CLD) | SD-SST: Peak cortisol < 500 nmol/L1 | 69% |
| Marik et al[12] | 340 (ALF: 24)(CLD: 146)(recent LT: 119)(remote LT: 51) | LD-SST: Peak cortisol < 552 nmol/L orrandom cortisol level < 414 nmol/L in non-stressed patients orrandom cortisol level < 552 nmol/L in stressed patients | 72%33%66%92%61% |
| Tsai et al[8] | 101 (cirrhosis+ severe sepsis) | SD-SST: Baseline cortisol < 414 nmol/L ordelta cortisol < 250 nmol/L if baseline cortisol between 414 and 938 nmol/L | 51% |
| Fernandez et al[13] | 25 (cirrhosis + septic shock) | SD-SST: Baseline cortisol < 414 nmol/L ordelta cortisol < 250 nmol/L if baseline cortisol between 414 and 966 nmol/L | 68% |
| Thierry et al[64] | 14 (cirrhosis + septic shock) | SD-SST: Baseline cortisol < 414 nmol/L; delta cortisol < 250 nmol/L | 77% |
| du Cheyron et al[65] | 50 (critically ill cirrhosis) | SD-SST: Baseline cortisol < 414 nmol/L; delta cortisol < 250 nmol/L if baseline cortisol between 414 and 938 nmol/L | 82% |
| Vasu et al[86] | 24 (critically ill cirrhotics) | SD-SST: Definition of AI was not reported | 62% |
| Arabi et al[29] | 75 (cirrhosis + septic shock) | SD-SST: Delta cortisol < 250 nmol/L | 76% |
| Mohamed et al[85] | 15 (cirrhosis+septic shock) | SD-SST: Definition of AI was not reported | 87% |
| Thevenot et al[74] | 30 (cirrhosis + sepsis) | SD-SST: Peak serum total cortisol < 510 nmol/L | 10% |
| Acevedo et al[89] | 166 (decompensated cirrhosis) | SD-SST: Delta cortisol < 250 nmol/L | 26% |
| Graupera et al[20] | 37 (severe acute bleeding) | SD-SST: Baseline cortisol < 414 nmol/L and/or delta cortisol < 250 nmol/L | 38% |
| Triantos et al[16] | 20 (cirrhosis with variceal bleeding) | SD-SST: Baseline cortisol < 276 nmol/L or delta cortisol < 250 nmol/LLD-SST: Peak serum cortisol < 690 nmol/L or a delta cortisol < 250 nmol/L | 30%60% |
| El Damarawy et al[66] | 45 (cirrhosis with septic shock or HRS, cirrhosis without septic shock or HRS) | SD-SST: Baseline cortisol < 414 nmol/L or delta cortisol < 250 nmol/L in patients with baseline cortisol < 966 nmol/L | 73% |
1
To convert serum total cortisol concentrations from nanomoles per liter to micrograms per deciliter divide by 27.59[79]. ALF: Acute liver failure; CLD: Chronic liver disease; HRS: Hepatorenal syndrome; LT: Liver transplant; AI: Adrenal insufficiency; SD-SST: Standard dose short synacthen test; LD-SST: Low dose short synacthen test.