Linked Life Data

16557538

Source:http://linkedlifedata.com/resource/pubmed/id/16557538

Statements in which the resource exists as a subject.
PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
4
pubmed:dateCreated
2006-3-29
pubmed:abstractText
Patients with cirrhosis are susceptible to bacterial infection, which can result in circulatory dysfunction, renal failure, hepatic encephalopathy, and a decreased survival rate. Severe sepsis is frequently associated with adrenal insufficiency, which may lead to hemodynamic instability and a poor prognosis. We evaluated adrenal function using short corticotropin stimulation test (SST) in 101 critically ill patients with cirrhosis and severe sepsis. Adrenal insufficiency occurred in 51.48% of patients. The patients with adrenal insufficiency had a higher hospital mortality rate when compared with those with normal adrenal function (80.76% vs. 36.7%, P < .001). The cumulative rates of survival at 90 days were 15.3% and 63.2% for the adrenal insufficiency and normal adrenal function groups, respectively (P < .0001). The hospital survivors had a higher cortisol response to corticotropin (16.2 +/- 8.0 vs. 8.5 +/- 5.9 microg/dL, P < .001). The cortisol response to corticotropin was inversely correlated with various disease severity, Model for End-Stage Liver Disease, and Child-Pugh scores. Acute physiology, age, chronic health evaluation III score, and cortisol increment were independent factors to predict hospital mortality. Mean arterial pressure on the day of SST was lower in patients with adrenal insufficiency (60 +/- 14 vs. 74.5 +/- 13 mm Hg, P < .001), and a higher proportion of these patients required vasopressors (73% vs. 24.48%, P < .001). Mean arterial pressure, serum bilirubin, vasopressor dependency, and bacteremia were independent factors that predicted adrenal insufficiency. In conclusion, adrenal insufficiency is common in critically ill patients with cirrhosis and severe sepsis. It is related to functional liver reserve and disease severity and is associated with hemodynamic instability, renal dysfunction, and increased mortality.
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
IM
pubmed:chemical
pubmed:status
MEDLINE
pubmed:month
Apr
pubmed:issn
0270-9139
pubmed:author
pubmed:issnType
Print
pubmed:volume
43
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
673-81
pubmed:dateRevised
2006-11-15
pubmed:meshHeading
pubmed-meshheading:16557538-Adrenal Glands, pubmed-meshheading:16557538-Adrenal Insufficiency, pubmed-meshheading:16557538-Adrenocorticotropic Hormone, pubmed-meshheading:16557538-Adult, pubmed-meshheading:16557538-Aged, pubmed-meshheading:16557538-Bacteremia, pubmed-meshheading:16557538-Bilirubin, pubmed-meshheading:16557538-Blood Pressure, pubmed-meshheading:16557538-Female, pubmed-meshheading:16557538-Hormones, pubmed-meshheading:16557538-Hospital Mortality, pubmed-meshheading:16557538-Humans, pubmed-meshheading:16557538-Hydrocortisone, pubmed-meshheading:16557538-Liver Cirrhosis, pubmed-meshheading:16557538-Male, pubmed-meshheading:16557538-Middle Aged, pubmed-meshheading:16557538-Predictive Value of Tests, pubmed-meshheading:16557538-Sepsis, pubmed-meshheading:16557538-Severity of Illness Index, pubmed-meshheading:16557538-Shock, Septic, pubmed-meshheading:16557538-Survival Analysis, pubmed-meshheading:16557538-Vasoconstrictor Agents
pubmed:year
2006
pubmed:articleTitle
Adrenal insufficiency in patients with cirrhosis, severe sepsis and septic shock.
pubmed:affiliation
Division of Gastroenterology, Chang Gung Memorial Hospital, Chia-Yi, Taipei, Taiwan.
pubmed:publicationType
Journal Article, Research Support, Non-U.S. Gov't