J Gastroenterol Hepatol. 2012 Oct;27(10):1596-1601. doi: 10.1111/j.1440-1746.2012.07188.x.
High serum levels of free cortisol indicate severity of cirrhosis in hemodynamically stable patients.

Thevenot T, Dorin R, Monnet E, Qualls CR, Sapin R, Grandclement E, Borot S, Sheppard F, Weil D, Degand T, Di Martino V, Kazlauskaite R.
Source

Department of Hepatology, University Hospital Jean Minjoz, France Laboratory of Metabolic and Endocrine Biochemistry, University Hospital Jean Minjoz, France Department of Endocrinology-Metabolism and Diabetology-Nutrition, University Hospital Jean Minjoz, France EA UPRES 3186 "Pathogen Agents and Inflammation," University of Franche-Comté, France Clinical Investigation Centre, Hospital Saint Jacques, Besançon cedex, France LINC-CNRS-UMR 7237, Strasbourg University, Strasbourg Cedex, France Department of Medicine, New Mexico VA Medical Center and University of New Mexico Health Science Center, USA Clinical Translational Science Center, University of New Mexico Health Science Center, Albuquerque, New Mexico, USA Departments of Preventive Medicine and Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Abstract

Background and Aim: We investigated: (i) the association between severity of cirrhosis and serum levels of free cortisol (SFC) and total cortisol (STC), measured before and 30min after (T(30) ) the low-dose 1-µg short synacthen test (LD-SST); and (ii) the prognostic value of SFC and STC. Methods: Consecutive, hemodynamically stable, cirrhotic patients (34 Child-Pugh class A, 29B, and 32C) underwent the LD-SST. Patients were followed for at least 12months to assess non-transplant-related mortality. Results: Child-Pugh class C patients had significantly higher basal levels of SFC than Child-Pugh class A or B patients. Prevalence of suspected adrenal dysfunction ranged between 7.4% (T(0) STC<138nmol/L) and 49.4% (change in STC <250nmol/L) according to the threshold used. In receiver-operator curve analysis, the area-under-the-curve values were 0.67 for T(30) SFC (0.51-0.79), 0.81 for Child-Pugh score (0.70-0.88), and 0.79 for albumin level (0.63-0.88). During the follow-up period, 16 patients with high T(30) SFC (≥78.9nmol/L) (26.2%) and one patient with low T(30) SFC (<78.9nmol/L) (3.4%) died (P=0.027 for high vs low T(30) SFC, log-rank test). Albeit not statistically significant, the risk of death for patients with T(30) SFC≥78.9nmol/L was fivefold higher than for patients with lower levels after adjusting for cirrhosis severity and level of albumin. Conclusions: One-year, non-transplant-related mortality is high among patients with T(30) levels of SFC ≥78.9nmol/L (26.2%). These findings might result from latent inflammatory stress in hemodynamically stable cirrhotic patients, detected by adrenal testing.

© 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

PMID: 22647073 [PubMed - as supplied by publisher]