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

Gastroenterología y Hepatología (English Edition) Pub Date : 2025-05-29 DOI:10.1016/j.gastre.2025.502322

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

{"title":"Prognostic value of relative adrenal insufficiency in patients with severe alcohol-associated hepatitis—A prospective clinical study","authors":"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","doi":"10.1016/j.gastre.2025.502322","DOIUrl":null,"url":null,"abstract":"<div><h3>Background/Aims</h3><div>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.</div></div><div><h3>Patients and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>p</em>  =0.991), serum creatinine (<em>p</em>  =0.986) and international normalized ratio (<em>p</em>  =0.040).</div></div><div><h3>Conclusions</h3><div>The presence of RAI seems to be a fair predictor of intermediate-term survival in AAH patients.</div></div>","PeriodicalId":100569,"journal":{"name":"Gastroenterología y Hepatología (English Edition)","volume":"48 6","pages":"Article 502322"},"PeriodicalIF":0.0000,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gastroenterología y Hepatología (English Edition)","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2444382425000690","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

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 60 min 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.

查看原文本刊更多论文

重度酒精相关性甲型肝炎患者相对肾上腺功能不全的预后价值

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值。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。结果共纳入首发AAH的25例受试者。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。

求助全文

约1分钟内获得全文求助全文

来源期刊

Gastroenterología y Hepatología (English Edition)

自引率

0.00%

发文量