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 |
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| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1097/MEG.0000000000000158 |
| format | Article |
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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<0.001, respectively]. In AVB compared with CC, median total serum cortisol24.3 versus 11.6 μg/dl (P<0.001), SC0.86 versus 0.407 μg/ml (P<0.001); FC 2.4 versus 0.57 μg/dl (P<0.001). In AVB, 5-day rebleeding was 10.5%, and 6-week and total mortality were 21.1 and 23.7%, respectively. Independent associations with 6-week mortality in AVB were FC at least 3.2 μg/dl (P<0.001), hepatocellular carcinoma (P<0.001), CPC (P<0.001), and early rebleeding (P<0.001). Among patients with normal cortisol-binding globulin (n=14) and albumin (n=31), the factors were hepatocellular carcinoma (P=0.003), CP (P=0.003), and FC (P=0.036). SC was also found to be an independent predictor of 6-week mortality (P<0.001). Area under the curve of FC for predicting 6-week mortality was 0.79.
CONCLUSIONHigher FC is present in cirrhosis with AVB compared with CC and is associated independently with bleeding-related mortality. However, whether high FC solely indicates the severity of illness or whether there is significant adrenal insufficiency cannot be discerned.]]></description><identifier>ISSN: 0954-691X</identifier><identifier>EISSN: 1473-5687</identifier><identifier>DOI: 10.1097/MEG.0000000000000158</identifier><identifier>PMID: 25089543</identifier><language>eng</language><publisher>England: Wolters Kluwer Health | Lippincott Williams & Wilkins</publisher><subject>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</subject><ispartof>European journal of gastroenterology & hepatology, 2014-10, Vol.26 (10), p.1125-1132</ispartof><rights>2014 Wolters Kluwer Health | Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3758-a705f1f80864362a30851c45d2f2c5cc168b428a928dbfc5b7c79ee56006beee3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25089543$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Triantos, Christos K</creatorcontrib><creatorcontrib>Kalafateli, Maria</creatorcontrib><creatorcontrib>Samonakis, Dimitrios</creatorcontrib><creatorcontrib>Zisimopoulos, Konstantinos</creatorcontrib><creatorcontrib>Papiamonis, Nikolaos</creatorcontrib><creatorcontrib>Sapountzis, Apostolos</creatorcontrib><creatorcontrib>Michalaki, Marina</creatorcontrib><creatorcontrib>Theocharis, Georgios</creatorcontrib><creatorcontrib>Thomopoulos, Konstantinos</creatorcontrib><creatorcontrib>Labropoulou-Karatza, Chryssoula</creatorcontrib><creatorcontrib>Kyriazopoulou, Venetsanea</creatorcontrib><creatorcontrib>Jelastopulu, Eleni</creatorcontrib><creatorcontrib>Kouroumalis, Elias A</creatorcontrib><creatorcontrib>Nikolopoulou, Vasiliki</creatorcontrib><creatorcontrib>Burroughs, Andrew K</creatorcontrib><title>Higher free serum cortisol is associated with worse survival in acute variceal bleeding because of cirrhosis: a prospective study</title><title>European journal of gastroenterology & hepatology</title><addtitle>Eur J Gastroenterol Hepatol</addtitle><description><![CDATA[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<0.001, respectively]. In AVB compared with CC, median total serum cortisol24.3 versus 11.6 μg/dl (P<0.001), SC0.86 versus 0.407 μg/ml (P<0.001); FC 2.4 versus 0.57 μg/dl (P<0.001). In AVB, 5-day rebleeding was 10.5%, and 6-week and total mortality were 21.1 and 23.7%, respectively. Independent associations with 6-week mortality in AVB were FC at least 3.2 μg/dl (P<0.001), hepatocellular carcinoma (P<0.001), CPC (P<0.001), and early rebleeding (P<0.001). Among patients with normal cortisol-binding globulin (n=14) and albumin (n=31), the factors were hepatocellular carcinoma (P=0.003), CP (P=0.003), and FC (P=0.036). SC was also found to be an independent predictor of 6-week mortality (P<0.001). Area under the curve of FC for predicting 6-week mortality was 0.79.
CONCLUSIONHigher FC is present in cirrhosis with AVB compared with CC and is associated independently with bleeding-related mortality. However, whether high FC solely indicates the severity of illness or whether there is significant adrenal insufficiency cannot be discerned.]]></description><subject>Acute Disease</subject><subject>Adrenal Cortex - metabolism</subject><subject>Adrenal Cortex - physiopathology</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Area Under Curve</subject><subject>Biomarkers - blood</subject><subject>Carcinoma, Hepatocellular - blood</subject><subject>Carcinoma, Hepatocellular - etiology</subject><subject>Carcinoma, Hepatocellular - mortality</subject><subject>Carrier Proteins - blood</subject><subject>Chi-Square Distribution</subject><subject>Esophageal and Gastric Varices - blood</subject><subject>Esophageal and Gastric Varices - diagnosis</subject><subject>Esophageal and Gastric Varices - etiology</subject><subject>Esophageal and Gastric Varices - mortality</subject><subject>Female</subject><subject>Gastrointestinal Hemorrhage - blood</subject><subject>Gastrointestinal Hemorrhage - diagnosis</subject><subject>Gastrointestinal Hemorrhage - etiology</subject><subject>Gastrointestinal Hemorrhage - mortality</subject><subject>Greece</subject><subject>Humans</subject><subject>Hydrocortisone - blood</subject><subject>Liver Cirrhosis - blood</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver Cirrhosis - mortality</subject><subject>Liver Function Tests</subject><subject>Liver Neoplasms - blood</subject><subject>Liver Neoplasms - etiology</subject><subject>Liver Neoplasms - mortality</subject><subject>Logistic Models</subject><subject>London</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>ROC Curve</subject><subject>Serum Albumin - metabolism</subject><subject>Serum Albumin, Human</subject><subject>Severity of Illness Index</subject><subject>Time Factors</subject><subject>Up-Regulation</subject><issn>0954-691X</issn><issn>1473-5687</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LxDAQhoMoun78A5EcvVSTtmlSbyJ-geJFwVtJ06mNdjdrJtnFo__cyKqIB3MZyDzzzvAQss_ZEWe1PL49vzxivx8Xao1MeCmLTFRKrpMJq0WZVTV_3CLbiM8JkQWXm2QrF0ylXjEh71f2aQBPew9AEXycUuN8sOhGapFqRGesDtDRpQ0DXTqPiYt-YRc6ETOqTQxAF9pbA-mnHQE6O3uiLRgdE-t6aqz3g0OLJ1TTuXc4BxPsIuWE2L3tko1ejwh7X3WHPFyc359dZTd3l9dnpzeZKaRQmZZM9LxXTFVlUeW6YEpwU4ou73MjjOGVastc6TpXXdsb0UojawBRMVa1AFDskMNVbrrgNQKGZmrRwDjqGbiIDU-okFIIntByhZp0LHrom7m3U-3fGs6aT_lNkt_8lZ_GDr42xHYK3c_Qt-0EqBWwdGMAjy9jXIJvhiQuDP9nfwAhzpLq</recordid><startdate>201410</startdate><enddate>201410</enddate><creator>Triantos, Christos K</creator><creator>Kalafateli, Maria</creator><creator>Samonakis, Dimitrios</creator><creator>Zisimopoulos, Konstantinos</creator><creator>Papiamonis, Nikolaos</creator><creator>Sapountzis, Apostolos</creator><creator>Michalaki, Marina</creator><creator>Theocharis, Georgios</creator><creator>Thomopoulos, Konstantinos</creator><creator>Labropoulou-Karatza, Chryssoula</creator><creator>Kyriazopoulou, Venetsanea</creator><creator>Jelastopulu, Eleni</creator><creator>Kouroumalis, Elias A</creator><creator>Nikolopoulou, Vasiliki</creator><creator>Burroughs, Andrew K</creator><general>Wolters Kluwer Health | Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201410</creationdate><title>Higher free serum cortisol is associated with worse survival in acute variceal bleeding because of cirrhosis: a prospective study</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3758-a705f1f80864362a30851c45d2f2c5cc168b428a928dbfc5b7c79ee56006beee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acute Disease</topic><topic>Adrenal Cortex - metabolism</topic><topic>Adrenal Cortex - physiopathology</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Area Under Curve</topic><topic>Biomarkers - blood</topic><topic>Carcinoma, Hepatocellular - blood</topic><topic>Carcinoma, Hepatocellular - etiology</topic><topic>Carcinoma, Hepatocellular - mortality</topic><topic>Carrier Proteins - blood</topic><topic>Chi-Square Distribution</topic><topic>Esophageal and Gastric Varices - blood</topic><topic>Esophageal and Gastric Varices - diagnosis</topic><topic>Esophageal and Gastric Varices - etiology</topic><topic>Esophageal and Gastric Varices - mortality</topic><topic>Female</topic><topic>Gastrointestinal Hemorrhage - blood</topic><topic>Gastrointestinal Hemorrhage - diagnosis</topic><topic>Gastrointestinal Hemorrhage - etiology</topic><topic>Gastrointestinal Hemorrhage - mortality</topic><topic>Greece</topic><topic>Humans</topic><topic>Hydrocortisone - blood</topic><topic>Liver Cirrhosis - blood</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver Cirrhosis - mortality</topic><topic>Liver Function Tests</topic><topic>Liver Neoplasms - blood</topic><topic>Liver Neoplasms - etiology</topic><topic>Liver Neoplasms - mortality</topic><topic>Logistic Models</topic><topic>London</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>ROC Curve</topic><topic>Serum Albumin - metabolism</topic><topic>Serum Albumin, Human</topic><topic>Severity of Illness Index</topic><topic>Time Factors</topic><topic>Up-Regulation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Triantos, Christos K</creatorcontrib><creatorcontrib>Kalafateli, Maria</creatorcontrib><creatorcontrib>Samonakis, Dimitrios</creatorcontrib><creatorcontrib>Zisimopoulos, Konstantinos</creatorcontrib><creatorcontrib>Papiamonis, Nikolaos</creatorcontrib><creatorcontrib>Sapountzis, Apostolos</creatorcontrib><creatorcontrib>Michalaki, Marina</creatorcontrib><creatorcontrib>Theocharis, Georgios</creatorcontrib><creatorcontrib>Thomopoulos, Konstantinos</creatorcontrib><creatorcontrib>Labropoulou-Karatza, Chryssoula</creatorcontrib><creatorcontrib>Kyriazopoulou, Venetsanea</creatorcontrib><creatorcontrib>Jelastopulu, Eleni</creatorcontrib><creatorcontrib>Kouroumalis, Elias A</creatorcontrib><creatorcontrib>Nikolopoulou, Vasiliki</creatorcontrib><creatorcontrib>Burroughs, Andrew K</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of gastroenterology & hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Triantos, Christos K</au><au>Kalafateli, Maria</au><au>Samonakis, Dimitrios</au><au>Zisimopoulos, Konstantinos</au><au>Papiamonis, Nikolaos</au><au>Sapountzis, Apostolos</au><au>Michalaki, Marina</au><au>Theocharis, Georgios</au><au>Thomopoulos, Konstantinos</au><au>Labropoulou-Karatza, Chryssoula</au><au>Kyriazopoulou, Venetsanea</au><au>Jelastopulu, Eleni</au><au>Kouroumalis, Elias A</au><au>Nikolopoulou, Vasiliki</au><au>Burroughs, Andrew K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Higher free serum cortisol is associated with worse survival in acute variceal bleeding because of cirrhosis: a prospective study</atitle><jtitle>European journal of gastroenterology & hepatology</jtitle><addtitle>Eur J Gastroenterol Hepatol</addtitle><date>2014-10</date><risdate>2014</risdate><volume>26</volume><issue>10</issue><spage>1125</spage><epage>1132</epage><pages>1125-1132</pages><issn>0954-691X</issn><eissn>1473-5687</eissn><abstract><![CDATA[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<0.001, respectively]. In AVB compared with CC, median total serum cortisol24.3 versus 11.6 μg/dl (P<0.001), SC0.86 versus 0.407 μg/ml (P<0.001); FC 2.4 versus 0.57 μg/dl (P<0.001). In AVB, 5-day rebleeding was 10.5%, and 6-week and total mortality were 21.1 and 23.7%, respectively. Independent associations with 6-week mortality in AVB were FC at least 3.2 μg/dl (P<0.001), hepatocellular carcinoma (P<0.001), CPC (P<0.001), and early rebleeding (P<0.001). Among patients with normal cortisol-binding globulin (n=14) and albumin (n=31), the factors were hepatocellular carcinoma (P=0.003), CP (P=0.003), and FC (P=0.036). SC was also found to be an independent predictor of 6-week mortality (P<0.001). Area under the curve of FC for predicting 6-week mortality was 0.79.
CONCLUSIONHigher FC is present in cirrhosis with AVB compared with CC and is associated independently with bleeding-related mortality. However, whether high FC solely indicates the severity of illness or whether there is significant adrenal insufficiency cannot be discerned.]]></abstract><cop>England</cop><pub>Wolters Kluwer Health | Lippincott Williams & Wilkins</pub><pmid>25089543</pmid><doi>10.1097/MEG.0000000000000158</doi><tpages>8</tpages></addata></record> |
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| subjects | 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 |
| title | Higher free serum cortisol is associated with worse survival in acute variceal bleeding because of cirrhosis: a prospective study |
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