Adrenal Insufficiency Associated with Low High-Density Lipoprotein (HDL) in Patients of Chronic Liver Disease

Abstract

Introduction Adrenal insufficiency is noted in patients of cirrhosis, mainly in critically ill patients. Cirrhosis characterized with low synthetic functions has multiple indirect markers for severity. Methodology 100 decompensated cirrhosis patients were hospitalized to Lady Hardinge Medical College in New Delhi as part of an observational cohort research from October 2014 to June 2016. Adrenocorticotrophic hormone stimulation test was done with 250 mcg, basal cortisol, and cortisol after 60 minutes of stimulation was noted. We investigated the relationship between blood HDL levels and adrenal insufficiency. Results Insufficient adrenal function was detected in 28% of the patients. INR, serum total bilirubin, serum creatinine, low high-density lipoprotein (HDL), child score, MELD score, plasma renin activity level, and renal resistive index were all associated with patients with adrenal insufficiency on univariate analysis. Multivariate analysis showed in patients with adrenal insufficiency, MELD score had odds ratio of 1.5 with AUC 0.724 (0.622-0.825), Bilirubin with odds ratio of 5.6 and AUC of 0.676 (0.679-0.882). Serum HDL with odds ratio of 6.1 (3.3-9.2) and AUC 0.822 (0.724-0.828) with P value <0.001, cut off calculated was 26 mg/dL with sensitivity of 81% and specificity of 85% predicts adrenal insufficiency. Patients with adrenal insufficiency had higher mortality. Conclusion Cirrhosis is associated with adrenal insufficiency, more with advanced liver disease. Low HDL level in blood can be taken as an indirect marker for adrenal insufficiency.