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Erschienen in: Intensive Care Medicine 1/2008

01.01.2008 | Original

Hyperreninemic hypoaldosteronism syndrome, plasma concentrations of interleukin-6 and outcome in critically ill patients with liver cirrhosis

verfasst von: Damien du Cheyron, Bruno Bouchet, Brigitte Cauquelin, Damien Guillotin, Michel Ramakers, Cédric Daubin, Jean-Jacques Ballet, Pierre Charbonneau

Erschienen in: Intensive Care Medicine | Ausgabe 1/2008

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Abstract

Objective

To investigate the relation between the adrenal production of gluco- and mineralocorticoids, the inflammatory status and the outcome in critically ill patients with liver cirrhosis.

Design

Prospective descriptive study.

Setting

Medical intensive care unit (ICU) in a university hospital.

Patients

Fifty consecutive patients with liver cirrhosis.

Interventions

A corticotropin stimulation test within 12 h following ICU admission. Plasma cortisol concentration was measured before and after the test. Renin and aldosterone concentrations, as well as interleukin-6 (IL-6) level to assess the pro-inflammatory status, were measured only before the test. Impaired adrenal function was defined as cortisol response to the test less than 9 μg/dl. Hyperreninemic hypoaldosteronism syndrome was defined as basal renin over aldosterone ratio (RRA) higher than 2.

Measurements and results

Forty-one (82%) patients had impaired adrenal function, and 26 patients (52%) presented with RRA > 2. Patients with RRA > 2 exhibited greater disease severity and organ dysfunction scores at baseline, higher levels of serum renin and IL-6, and a greater ICU mortality rate, but risk-adjusted mortality rates were not different between the two groups. Renin and IL-6 plasma concentrations were positively correlated. Finally, in a Cox regression analysis, independent predictors of 30-day mortality were hyperreninemic hypoaldosteronism syndrome, IL-6 higher than 400 pg/ml and severe renal failure.

Conclusions

Adrenal dysfunction was common in critically ill cirrhotic patients. Hyperreninemic hypoaldosteronism syndrome was related to a greater pro-inflammatory status and degree of acute organ failure, and was independently associated with a worse prognosis.
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Metadaten
Titel
Hyperreninemic hypoaldosteronism syndrome, plasma concentrations of interleukin-6 and outcome in critically ill patients with liver cirrhosis
verfasst von
Damien du Cheyron
Bruno Bouchet
Brigitte Cauquelin
Damien Guillotin
Michel Ramakers
Cédric Daubin
Jean-Jacques Ballet
Pierre Charbonneau
Publikationsdatum
01.01.2008
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 1/2008
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-007-0864-z

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