Abstract
Background
There are few data on clinical relevance of adrenal dysfunction and its relationship
with occult microbial DNA in noninfected haemodynamically stable cirrhotic patients
with ascites.
Aims
The aim of this study was to evaluate prognostic role of adrenal dysfunction, microbial
DNA, and their relationship.
Methods
Adrenal function was assessed in 93 consecutive patients following a corticotropin
stimulation test. Adrenal dysfunction was defined as: basal cortisol <10 μg/dl, delta cortisol <9 μg/dl, or peak cortisol <18 μg/dl. Microbial DNA was assessed in blood and ascites of 54 consecutive patients.
Patients were followed up until liver transplantation or death.
Results
Adrenal dysfunction was not significantly associated with mortality, while the risk
of death rose significantly with an increase in basal cortisol values (HR 1.13 per
1-μl/dl increase; 95% CI 1.01–1.26). Microbial DNA was independently associated with
reduced survival (HR 8.05, 95% CI 1.57–41.2). In microbial DNA-positive patients a
significant correlation was found between Model for End-Stage Liver Disease (MELD)
score and basal cortisol values (Pearson's r = 0.5107; p = 0.018).
Conclusions
Microbial DNA and MELD score, but not adrenal function, were the best independent
predictors of mortality in noninfected cirrhotic patients with ascites. High serum
cortisol levels may be a systemic reaction to microbial translocation, increasing
in parallel with deterioration of liver function.
Keywords
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Article info
Publication history
Published online: May 16, 2015
Accepted:
April 16,
2015
Received:
November 11,
2014
Identification
Copyright
© 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Inc. All rights reserved.
