Update on adrenal insufficiency in patients with liver cirrhosis

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%

¹To 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.