Prognostic value of relative adrenal insufficiency in patients with severe alcohol-associated hepatitis-A prospective clinical study.

IF 2.2 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia Pub Date : 2024-12-12 DOI:10.1016/j.gastrohep.2024.502322

Raúl Alberto Jiménez-Castillo, Carlos Eugenio González-Martínez, Elianee María Tovar-Bojorquez, Carlos Alejandro Cortez-Hernández, Joel Omar Jaquez-Quintana, José Alberto González-González, José Gerardo González-González, Héctor Jesús Maldonado-Garza

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引用次数: 0

Abstract

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.

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重度酒精相关性肝炎患者相对肾上腺功能不全的预后价值——一项前瞻性临床研究

背景/目的：相对肾上腺功能不全（RAI）是肝硬化患者的常见病，并影响其预后。关于酒精相关性肝炎（AAH）患者RAI的数据很少。本研究的目的是记录严重AAH患者RAI的患病率和预后意义。患者和方法：选择首次发作AAH的成年人。δ皮质醇水平为ACTH刺激后60分钟血清基础皮质醇的差异。采用Cox比例风险回归模型对预后因素进行单因素分析，置信区间为95%。应用Kaplan-Meier检验和log-rank检验进行RAI和非RAI患者的生存分析。结果：纳入了25例首次发作AAH的受试者。我们的队列中有8例（32.0%）死亡。单因素分析显示，RAI的存在（p = 0.049）对90天总生存期（OS）有显著影响。血清白蛋白（p = 0.991）、血清肌酐（p = 0.954）、钠（p = 0.986）和国际标准化比值（p = 0.073）对90天生存期无显著影响。RAI患者的90天总生存率为50.0%，非RAI患者为90.9%，差异有统计学意义（p=0.040）。结论：RAI的存在似乎是AAH患者中期生存的一个公平的预测因子。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gastroenterologia y hepatologia GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

1.50

自引率

10.50%

发文量

147

审稿时长

48 days

期刊介绍： Gastroenterology and Hepatology is the first journal to cover the latest advances in pathology of the gastrointestinal tract, liver, pancreas, and bile ducts, making it an indispensable tool for gastroenterologists, hepatologists, internists and general practitioners.