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Prognostic value of relative adrenal insufficiency in patients with severe alcohol-associated hepatitis-A prospective
Raúl Alberto Jiménez-Castillo1, Carlos Eugenio González-Martínez1, Elianee María Tovar-Bojorquez1
1Gastroenterology Department, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico.
Background/Aims:
Relative adrenal insufficiency (RAI) is frequent in patients with liver cirrhosis and affects their prognosis. Scarce data on RAI in patients with alcohol-associated hepatitis (AAH) exists. This study aimed to document the prevalence and prognostic implication of RAI in patients with severe AAH.
Patients And Methods:
Adults with a first episode of AAH were selected. The delta cortisol level was the difference between the serum basal cortisol and 60min after ACTH stimulation. Cox proportional-hazard regression model was used for univariate analysis of prognostic factors with 95% confidence intervals. The Kaplan-Meier and log-rank tests were applied for survival analysis between patients with RAI and without RAI.
Results:
Twenty-five subjects with a first episode of AAH were included. Eight (32.0%) deaths occurred in our cohort. Univariate analysis showed that presence of RAI (p=0.049) had a significant impact on 90-day Overall Survival (OS). Serum albumin (p=0.991), serum creatinine (p=0.954), sodium (p=0.986) and international normalized ratio (p=0.073) did not show a significant impact on 90-day OS. Ninety-day overall survival for patients with RAI was 50.0% vs. 90.9% in those without RAI, (p=0.040).
Conclusions:
The presence of RAI seems to be a fair predictor of intermediate-term survival in AAH patients.
