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01-01-2008 | Original

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

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

Published in: Intensive Care Medicine | Issue 1/2008

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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Title: Hyperreninemic hypoaldosteronism syndrome, plasma concentrations of interleukin-6 and outcome in critically ill patients with liver cirrhosis
Authors: Damien du Cheyron
Bruno Bouchet
Brigitte Cauquelin
Damien Guillotin
Michel Ramakers
Cédric Daubin
Jean-Jacques Ballet
Pierre Charbonneau
Publication date: 01-01-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 1/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0864-z

ACC 2024 Congress

Springer Medicine

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

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

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