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

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.

Keywords: Adrenal insufficiency; Alcohol-associated hepatitis; Cortisol; Hepatitis asociada al alcohol; Insuficiencia suprarrenal; Insuficiencia suprarrenal relativa; Outcomes; Relative adrenal insufficiency; Resultados.