Adrenal Insufficiency in Alcoholic Hepatitis: Unveiling Its Role in Steroid Therapy Outcome

Background/Aims: Patients with severe alcoholic hepatitis (SAH) exhibit many hemodynamic similarities to critically ill patients. While steroids are linked to better short-term mortality in SAH patients, they also increase the risk of infections, acute kidney injury, and gastrointestinal bleeding. This study hypothesizes that relative adrenal insufficiency (RAI) is prevalent in SAH and could influence the effectiveness of steroids. The objectives are to evaluate RAI in alcoholic hepatitis (AH) patients, compare RAI with the severity of AH, and correlate the efficacy of steroids with RAI in SAH patients. Materials and Methods: Newly diagnosed AH cases hospitalized at JLN Hospital were enrolled. AH patients were classified using the Maddrey discriminant function (DF) into mild and severe categories. Baseline serum cortisol was measured, followed by an intramuscular injection of 25 IU adrenocorticotrophic hormone, with a subsequent blood sample taken after 1 h to assess serum cortisol. SAH patients were divided into two groups: Those with RAI and those without. Both groups received standard steroid treatment for 7 days, and their responses were evaluated on day seven using the Lille score. Results: The study included 135 AH patients, with 55 excluded, leaving 80 participants. Among them, 20 had mild AH, and 60 had severe AH. None of the mild AH patients had RAI, whereas 32 out of 60 severe AH patients (53.33%) had RAI ( P < 0.0001). There was a significant negative correlation between delta cortisol and DF. However, the correlation between steroid response and RAI was not significant ( P = 0.886). Conclusion: RAI is common in SAH patients and correlates with the severity of liver disease, but it does not significantly impact the outcome of steroid treatment in these patients.