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

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• 作者：Damien du Cheyron (1)
  Bruno Bouchet (1)
  Brigitte Cauquelin (2)
  Damien Guillotin (1)
  Michel Ramakers (1)
  Cédric Daubin (1)
  Jean-Jacques Ballet (2)
  Pierre Charbonneau (1)
  
• 关键词：Adrenal function ; Cortisol ; Renin–angiotensin System ; Interleukin ; 6 ; Liver cirrhosis ; Intensive care units ; Prognosis
• 刊名：Intensive Care Medicine
• 出版年：2008
• 出版时间：January 2008
• 年：2008
• 卷：34
• 期：1
• 页码：116-124
• 全文大小：194KB
• 参考文献：1. Shellman?RG, Fulkerson?WJ, DeLong?E, Piantadosi?CA (1988) Prognosis of patients with cirrhosis and chronic liver disease admitted to the medical intensive care unit. Crit Care Med 16:671-78 CrossRef
  2. Moreau?R, Hadengue?A, Soupison?T, Kirstetter?P, Mamzer?MF, Vanjak?D, Vauquelin?P, Assous?M, Sicot?C (1992) Septic shock in patients with cirrhosis: hemodynamic and metabolic characteristics and intensive care unit outcome. Crit Care Med 20:746-50 CrossRef
  3. Moreau?R, Lebrec?D (2003) Acute renal failure in patients with cirrhosis: perspectives in the age of MELD. Hepatology 37:233-43 CrossRef
  4. du Cheyron?D, Bouchet?B, Parienti?JJ, Ramakers?M, Charbonneau?P (2005) The attributable mortality of acute renal failure in critically ill patients with liver cirrhosis. Intensive Care Med 31:1693-699 CrossRef
  5. Gines?P, Cardenas?A, Arroyo?V, Rodes?J (2004) Management of cirrhosis and ascites. N Engl J Med 350:1646-654 CrossRef
  6. Wong?F, Bernardi?M, Balk?R, Christman?B, Moreau?R, Garcia-Tsao?G, Patch?D, Soriano?G, Hoefs?J, Navasa?M (2005) Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club. Gut 54:718-25 CrossRef
  7. Wasmuth?HE, Kunz?D, Yagmur?E, Timmer-Stranghoner?A, Vidacek?D, Siewert?E, Bach?J, Geier?A, Purucker?EA, Gressner?AM, Matern?S, Lammert?F (2005) Patients with acute on chronic liver failure display “sepsis-like-immune paralysis. J Hepatol 42:195-01 CrossRef
  8. Annane?D, Sebille?V, Troche?G, Raphael?JC, Gajdos?P, Bellissant?E (2000) A?3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin. JAMA 283:1038-045 CrossRef
  9. Annane?D, Sebille?V, Charpentier?C, Bollaert?PE, Francois?B, Korach?JM, Capellier?G, Cohen?Y, Azoulay?E, Troche?G, Chaumet-Riffaut?P, Bellissant?E (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862-71 CrossRef
  10. du Cheyron?D, Lesage?A, Daubin?C, Ramakers?M, Charbonneau?P (2003) Hyperreninemic hypoaldosteronism: a?possible etiological factor of septic shock-induced acute renal failure. Intensive Care Med 29:1703-709 CrossRef
  11. Zipser?RD, Davenport?MW, Martin?KL, Tuck?ML, Warner?NE, Swinney?RR, Davis?CL, Horton?R (1981) Hyperreninemic hypoaldosteronism in the critically ill: a?new entity. J Clin Endocrinol Metab 53:867-73
  12. Davenport?MW, Zipser?RD (1983) Association of hypotension with hyperreninemic hypoaldosteronism in the critically ill patient. Arch Intern Med 143:735-37 CrossRef
  13. Findling?JW, Waters?VO, Raff?H (1987) The dissociation of renin and aldosterone during critical illness. J Clin Endocrinol Metab 64:592-95 CrossRef
  14. Tsai?MH, Peng?YS, Chen?YC, Liu?NJ, Ho?YP, Fang?JT, Lien?JM, Yang?C, Chen?PC, Wu?CS (2006) Adrenal insufficiency in patients with cirrhosis, severe sepsis and septic shock. Hepatology 43:673-81 CrossRef
  15. O'Connor?PG, Schottenfeld?RS (1998) Patients with alcohol problems. N Engl J Med 338:592-02 CrossRef
  16. Pugh?RN, Murray-Lyon?IM, Dawson?JL, Pietroni?MC, Williams?R (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646-49 CrossRef
  17. Kamath?PS, Wiesner?RH, Malinchoc?M, Kremers?W, Therneau?TM, Kosberg?CL, D'Amico?G, Dickson?ER, Kim?WR (2001) A?model to predict survival in patients with end-stage liver disease. Hepatology 33:464-70 CrossRef
  18. Unger?N, Lopez Schmidt?I, Pitt?C, Walz?MK, Philipp?T, Mann?K, Petersenn?S (2004) Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in patients with an adrenal mass. Eur J Endocrinol 150:517-23 CrossRef
  19. Colle?I, Moreau?R, Pessione?F, Rassiat?E, Heller?J, Chagneau?C, Pateron?D, Barriere?E, Condat?B, Sogni?P, Valla?D, Lebrec?D (2001) Relationships between haemodynamic alterations and the development of ascites or refractory ascites in patients with cirrhosis. Eur J Gastroenterol Hepatol 13:251-56 CrossRef
  20. Laragh?JH, Sealey?JE (1973) The renin–angiotensin–aldosterone hormonal system and regulation of sodium, potassium, and blood pressure homeostasis. In: Orloff?J, Berliner?RW (eds) Handbook of physiology. Am Physiol Soc, Bethesda, MD, pp 831-07
  21. Moller?S, Bendtsen?F, Henriksen?JH (2006) Determinants of the renin–angiotensin–aldosterone system in cirrhosis with special emphasis on the central blood volume. Scand J Gastroenterol 41:451-58 CrossRef
  22. Marik?PE, Gayowski?T, Starzl?TE (2005) The hepatoadrenal syndrome: a?common yet unrecognized clinical condition. Crit Care Med 33:1254-259 CrossRef
  23. Marik?PE (2006) Adrenal-exhaustion syndrome in patients with liver disease. Intensive Care Med 32:275-80 CrossRef
  24. Doe?RP, Fernandez?R, Seal?US (1964) Measurement of corticosteroid-binding globulin in man. J Clin Endocrinol Metab 24:1029-039
  25. Hamrahian?AH, Oseni?TS, Arafah?BM (2004) Measurements of serum free cortisol in critically ill patients. N Engl J Med 350:1629-638 CrossRef
  26. Beishuizen?A, Thijs?LG (2001) Relative adrenal failure in intensive care: an identifiable problem requiring treatment? Best Pract Res Clin Endocrinol Metab 15:513-31 CrossRef
  27. Annane?D, Bellissant?E, Cavaillon?JM (2005) Septic shock. Lancet 365:63-8 CrossRef
  28. Prigent?H, Maxime?V, Annane?D (2004) Science review: mechanisms of impaired adrenal function in sepsis and molecular actions of glucocorticoids. Crit Care 8:243-52 CrossRef
  29. Deutschman?CS, Cereda?M, Ochroch?EA, Raj?NR (2006) Sepsis-induced cholestasis, steatosis, hepatocellular injury, and impaired hepatocellular regeneration are enhanced in interleukin-6 --mice. Crit Care Med 34:2613-620 CrossRef
  30. Kullmer?T, Haak?T, Winkelmann?BR, Morbitzer?D, Jungmann?E, Meier-Sydow?J (1996) Hormonal modifications in patients admitted to an internal intensive care unit for acute hypoxaemic respiratory failure. Respir Med 90:601-08 CrossRef
  31. Rolih?CA, Ober?KP (1995) The endocrine response to critical illness. Med Clin North Am 79:211-24
  32. Raff?H, Findling?JW (1990) Aldosterone control in critically ill patients: ACTH, metoclopramide, and atrial natriuretic peptide. Crit Care Med 18:915-20 CrossRef
  33. Lichtarowicz-Krynska?EJ, Cole?TJ, Camacho-Hubner?C, Britto?J, Levin?M, Klein?N, Aynsley-Green?A (2004) Circulating aldosterone levels are unexpectedly low in children with acute meningococcal disease. J Clin Endocrinol Metab 89:1410-414 CrossRef
  34. Sellars?L, Shore?AC, Mott?V, Wilkinson?R (1985) The renin–angiotensin–aldosterone system in decompensated cirrhosis: its activity in relation to sodium balance. Q J Med 56:485-96
  35. Fernandez?J, Escorsell?A, Zabalza?M, Felipe?V, Navasa?M, Mas?A, Lacy?AM, Gines?P, Arroyo?V (2006) Adrenal insufficiency in patients with cirrhosis and septic shock: effect of treatment with hydrocortisone on survival. Hepatology 44:1288-295 CrossRef
  36. Knaus?WA, Draper?EA, Wagner?DP, Zimmerman?JE (1985) APACHE II: a?severity of disease classification system. Crit Care Med 13:818-29 CrossRef
  37. Vincent?JL, Moreno?R, Takala?J, Willatts?S, De Mendonca?A, Bruining?H, Reinhart?CK, Suter?PM, Thijs?LG (1996) The?SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707-10 CrossRef
  
• 作者单位：Damien du Cheyron (1)
  Bruno Bouchet (1)
  Brigitte Cauquelin (2)
  Damien Guillotin (1)
  Michel Ramakers (1)
  Cédric Daubin (1)
  Jean-Jacques Ballet (2)
  Pierre Charbonneau (1)
  
  1. Service de Réanimation Médicale, CHU de Caen, Av c?te de Nacre, 14033, Caen Cedex, France
  2. Laboratoire d’Immunologie et Immunopathologie, and UPRES-EA 2128, CHU de Caen, Av c?te de Nacre, 14000, Caen, France
  

文摘

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 >-. Patients with RRA >- 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.