SUN-433 The Double Burden of Cirrhosis and Adrenal Insufficiency: Insights from a Retrospective Cohort Study

Abstract Disclosure: M.J. Barnett: None. J.R. Lam: None. C. Casipit: None. A. Rivadeneira: None. Introduction: Adrenal insufficiency (AI) significantly affects patients with cirrhosis, contributing to morbidity and mortality. We assess the effect of adrenal insufficiency on clinical outcomes among cirrhotic patients, focusing on mortality, risk of sepsis and severe sepsis. Methodology: This retrospective study utilized the TriNetX platform to compare outcomes in two cohorts of cirrhotic patients: those with adrenal insufficiency (AI; N=7,890) and those without adrenal insufficiency (NO AI; N=688,085). Propensity score matching (1:1) was employed to balance baseline characteristics, resulting in matched cohorts of 7,872 patients each. Outcomes included mortality, sepsis, severe sepsis, and hepatic encephalopathy. Patients with prior outcomes were excluded from the analysis. Across all outcomes, 2,595 patients in the With AI group and 869 in the Without AI group were excluded. Results: During the selection process for the cohort, a total of 724,440 patients were identified with cirrhosis of the liver. Among these, 7,890 (1.09%) developed concomitant AI after the diagnosis of cirrhosis, corresponding to approximately 1,089 cases per 100,000 cirrhosis patients. Demographically, the average age of patients in both groups was 63.5 years. Gender distribution was similar, with 44% of patients being female. Race and ethnicity were also comparable, with 61% identified as White. The risk of all-cause mortality was significantly higher in the AI group (41.9%) compared to the NO AI group (26.0%), with a relative risk (RR) of 1.613 (95% CI: 1.541-1.688). Sepsis risk (RR: 1.569; 95% CI: 1.439-1.712) and severe sepsis (3.2% versus 8.5%; RR: 1.548; 95% CI: 1.396-1.717), and hepatorenal syndrome (4.6% vs. 2.9%; RR: 1.575; 95% CI: 1.331-1.865) were all higher in the AI group vs the NO AI group. Risks of esophageal varices were reduced in the AI group (7.5% vs. 11.6%; RR: 0.648; 95% CI: 0.578-0.727). The AI group also demonstrated a higher rate of liver transplants (5.8% vs. 3.2%; RR: 1.783; 95% CI: 1.527-2.083). For hepatic encephalopathy, (7.0% vs. 6.9%; RR: 1.014, 95% CI: 0.898-1.146) and ascites (16.4% vs. 17.9%; RR: 0.918, 95% CI: 0.838-1.005) risk was not statistically significant between the two groups. Conclusion: Adrenal insufficiency in cirrhosis patients is associated with higher risks of mortality and sepsis, highlighting its significant impact on outcomes. Careful monitoring and management of adrenal insufficiency in cirrhosis are critical to improving patient outcomes. Further research should explore targeted interventions for this high-risk population. Presentation: Sunday, July 13, 2025