Adrenal function and microbial DNA in noninfected cirrhotic patients with ascites: Relationship and effect on survival. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Risso, Alessandro; Alessandria, Carlo; Mezzabotta, Lavinia; Elia, Chiara; Andrealli, Alida; Spandre, Maurizio; Di Luigi, Paola; Barbui, Anna; Evangelista, Andrea; Morgando, Anna; Serra, Roberto; Ciccone, Giovannino; Marzano, Alfredo; Rizzetto, Mario
• Is Part Of: Digestive and liver disease. Volume 47:Issue 8(2015)
• Page Start: 702
• Page End: 708
• Publication Date: 2015-08
• Subjects: Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2015.04.010
• Languages: English
• ISSNs: 1590-8658

Abstract

<abstract abstract-type="author" id="abs0005"> <title id="sect0005">Abstract</title> <sec> <title id="sect0010">Background</title> <p id="spar0005">There are few data on clinical relevance of adrenal dysfunction and its relationship with occult microbial DNA in noninfected haemodynamically stable cirrhotic patients with ascites.</p> </sec> <sec> <title id="sect0015">Aims</title> <p id="spar0010">The aim of this study was to evaluate prognostic role of adrenal dysfunction, microbial DNA, and their relationship.</p> </sec> <sec> <title id="sect0020">Methods</title> <p id="spar0015">Adrenal function was assessed in 93 consecutive patients following a corticotropin stimulation test. Adrenal dysfunction was defined as: basal cortisol <10 μg/dl, delta cortisol <9 μg/dl, or peak cortisol <18 μg/dl. Microbial DNA was assessed in blood and ascites of 54 consecutive patients. Patients were followed up until liver transplantation or death.</p> </sec> <sec> <title id="sect0025">Results</title> <p id="spar0020">Adrenal dysfunction was not significantly associated with mortality, while the risk of death rose significantly with an increase in basal cortisol values (HR 1.13 per 1-μl/dl increase; 95% CI 1.01–1.26). Microbial DNA was independently associated with reduced survival (HR 8.05, 95% CI 1.57–41.2). In microbial DNA-positive patients a significant correlation was found between Model for End-Stage Liver Disease (MELD) score and basal cortisol values (Pearson's <italic>r</italic> = 0.5107; <italic>p</italic> = 0.018).</p> </sec> <sec> <title id="sect0030">Conclusions</title> <p id="spar0025">Microbial DNA and MELD score, but not adrenal function, were the best independent predictors of mortality in noninfected cirrhotic patients with ascites. High serum cortisol levels may be a systemic reaction to microbial translocation, increasing in parallel with deterioration of liver function.</p> </sec> </abstract>