Adrenal insufficiency in patients with decompensated cirrhosis

Table 4 Characteristics and outcomes of the included studies of patients treated with steroids

Ref.	Study design; studyperiod; country	No. of patients;type of liver disease	Hydrocortisone	Outcome
Etogo-Asse et al[49]	Prospective, observational; 2007-2009; United Kingdom	51 critical ill cirrhotic patients required vasopressors	31 received hydrocortisone of a median dose of 200 mg/d	Mortality: 13/20 (65%) in those who did not and 20/31 (65%) in those who received corticosteroid
Arabi et al[48]	Randomized double blind; 2004-2007; Saudi Arabi	75 patients; septic shock and cirrhosis in ICU	39 patients received 200 mg hydrocortisone iv/d vs 36 patients receiving normal saline until shock resolution	Shock reversal: 24/39 (62%) with hydrocortisone vs 14/36 (39%) with placebo (P = 0.05) Shock relapse after tapering: 13/39 (34%) vs 5/36 (14%) (P = 0.03) 28 d mortality: 33/39 (85%) vs 26/36 (72%), (P = 0.19) Increase in gastrointestinal bleeding (P = 0.02) in hydrocortisone group
du Cheyron et al[6]	Prospective; 2003-2005; France	31 AOCLD with AI	14 treated with stress doses of cortisol vs 17 not treated	30 d mortality: 7/14 (50%) of those treated vs 12/17 (70%) not treated (P = 0.29)
Fernández et al[53]	Prospective and retrospective; group 1 2004-2006, group 2 2001-2004	Group 1: 17 patients; cirrhosis and septic shock and AI Group 2: 50 patients; no assessment of adrenal function	17 patients of group 1 treated with 200 mg hydrocortisone/d vs 50 patients not treated	Mortality: group 1 32% vs 62% in group 2 in ICU (P = 0.03), 36% vs 68% (P = 0.003) in hospital Septic shock resolved in 96% vs 58% in group 2 (P = 0.001)
Marik et al[4]	Retrospective; 2002-2004; United States	140 patients vasopressor depended with ALD or CLD and AI	300 mg hydrocortisone/d	Reduction in dose of norepinephrin in the 24 h (P = 0.02) in those with AI treated with hydrocortisone and increase in those with AI not treated (P = 0.04) Mortality: 26% in those treated with steroids and 46% in not treated (P = 0.002)
Harry et al[69]	Retrospective; 1999-2001; United Kingdom	40 patients with ALD or AOCLD required vasopressors	20 patients treated with 300 mg hydrocortisone/d vs 20 patients not treated	In the group of 20 patients treated, there was reduction in doses of norepinephrin, higher risk of infections and no benefit in survival compared with the 20 patients not treated

CLD: Chronic liver disease; ICU: Intensive care unit; ALD: Acute liver disease; AOCLD: Acute on chronic liver disease; AI: Adrenal insufficiency.