Higher free serum cortisol is associated with worse survival in acute variceal bleeding because of cirrhosis: a prospective study

BACKGROUND AND AIMSCritical illness-related corticosteroid insufficiency has been reported in acute variceal bleeding (AVB). In cirrhosis, free serum cortisol (FC) is considered optimal to assess adrenal function. Salivary cortisol (SC) is considered a surrogate for FC. We evaluated FC and its progn...

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Veröffentlicht in:	European journal of gastroenterology & hepatology 2014-10, Vol.26 (10), p.1125-1132
Hauptverfasser:	Triantos, Christos K, Kalafateli, Maria, Samonakis, Dimitrios, Zisimopoulos, Konstantinos, Papiamonis, Nikolaos, Sapountzis, Apostolos, Michalaki, Marina, Theocharis, Georgios, Thomopoulos, Konstantinos, Labropoulou-Karatza, Chryssoula, Kyriazopoulou, Venetsanea, Jelastopulu, Eleni, Kouroumalis, Elias A, Nikolopoulou, Vasiliki, Burroughs, Andrew K
Format:	Artikel
Sprache:	eng
Schlagworte:	Acute Disease Adrenal Cortex - metabolism Adrenal Cortex - physiopathology Adult Aged Aged, 80 and over Area Under Curve Biomarkers - blood Carcinoma, Hepatocellular - blood Carcinoma, Hepatocellular - etiology Carcinoma, Hepatocellular - mortality Carrier Proteins - blood Chi-Square Distribution Esophageal and Gastric Varices - blood Esophageal and Gastric Varices - diagnosis Esophageal and Gastric Varices - etiology Esophageal and Gastric Varices - mortality Female Gastrointestinal Hemorrhage - blood Gastrointestinal Hemorrhage - diagnosis Gastrointestinal Hemorrhage - etiology Gastrointestinal Hemorrhage - mortality Greece Humans Hydrocortisone - blood Liver Cirrhosis - blood Liver Cirrhosis - complications Liver Cirrhosis - diagnosis Liver Cirrhosis - mortality Liver Function Tests Liver Neoplasms - blood Liver Neoplasms - etiology Liver Neoplasms - mortality Logistic Models London Male Middle Aged Multivariate Analysis Predictive Value of Tests Prognosis Proportional Hazards Models Prospective Studies Risk Factors ROC Curve Serum Albumin - metabolism Serum Albumin, Human Severity of Illness Index Time Factors Up-Regulation
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Zusammenfassung:	BACKGROUND AND AIMSCritical illness-related corticosteroid insufficiency has been reported in acute variceal bleeding (AVB). In cirrhosis, free serum cortisol (FC) is considered optimal to assess adrenal function. Salivary cortisol (SC) is considered a surrogate for FC. We evaluated FC and its prognostic role in AVB. METHODSTotal serum cortisol, SC, cortisol-binding globulin, and FC (Coolens’ formula) were evaluated in AVB (n=38) and in stable cirrhosis (CC) (n=31). A Cox proportional hazards model was evaluated for 6-week survival. RESULTSIn AVB, the median FC and SC levels were higher with worse liver dysfunction [Child–Pugh (CP) A/B/C1.59/2.62/3.26 μg/dl, P=0.019; CPA/B/C0.48/0.897/1.81 μg/ml, P
ISSN:	0954-691X 1473-5687
DOI:	10.1097/MEG.0000000000000158