Corticosteroids reduce inotrope requirements in hypotensive liver failure

Introduction

Corticosteroids improve haemodynamic profile in patients with septic shock [1,2]. Adrenal dysfunction is common in patients with acute hepatic necrosis (AHN) and haemodynamic instability [3].

Methods

We studied 13 patients aged between 19 and 63 years with liver failure defined by the presence of encephalopathy and hypotension requiring noradrenaline (NA) support despite adequate fluid resuscitation. Eleven patients had AHN and two decompensated alcoholic cirrhosis. Treatment with 300 mg hydrocortisone daily by infusion was started when BP required NA support. Baseline, incremental rise and peak cortisols following 250 µg intravenous synacthen were recorded, as were NA requirements and mean arterial BP for 24 hours before and 24 and 48 hours after the start of corticosteroids.

Results

NA was given for a median of 2 days prior to steroid therapy. Three patients survived, eight died and one underwent liver transplantation (OLT).

Of those who came off NA (seven), three required further NA and all died; four required no further inotropes of which three survived and one underwent OLT.

There were no differences between baseline, increment and peak cortisols between those who became inotrope independent and those who did not using the Mann-Whitney test.

Conclusion

Low dose corticosteroids improve the haemodynamic profile in patients with hypotensive liver failure and may improve survival. This may not be dependent upon endogenous adrenal function.

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