Low Baseline but Not Delta Cortisol Relates to 28-Day Transplant-Free Survival in Acute and Acute-on-Chronic Liver Failure

Sofia Roth; Emilio Flint; Lea Ghataore; Vishal C. Patel; Arjuna Singanayagam; Royce P. Vincent; Evangelos Triantafyllou; Yun Ma; William Bernal; Georg Auzinger; Michael Heneghan; Charalambos Antoniades; Mirjam Christ-Crain; Mark J.W. McPhail; David R. Taylor; Julia Wendon; Christine Bernsmeier

Gastro Hep Advances (Jan 2023)

Low Baseline but Not Delta Cortisol Relates to 28-Day Transplant-Free Survival in Acute and Acute-on-Chronic Liver Failure

Sofia Roth,
Emilio Flint,
Lea Ghataore,
Vishal C. Patel,
Arjuna Singanayagam,
Royce P. Vincent,
Evangelos Triantafyllou,
Yun Ma,
William Bernal,
Georg Auzinger,
Michael Heneghan,
Charalambos Antoniades,
Mirjam Christ-Crain,
Mark J.W. McPhail,
David R. Taylor,
Julia Wendon,
Christine Bernsmeier

Affiliations

Sofia Roth: Department of Biomedicine, University of Basel and University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland; Correspondence: Address correspondence to: Sofia Roth, MD, Department of Biomedicine, University of Basel and University Centre for Gastrointestinal and Liver Diseases, Hebelstrasse 20, Basel 4031, Switzerland.
Emilio Flint: Department of Biomedicine, University of Basel and University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland
Lea Ghataore: Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
Vishal C. Patel: Liver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK
Arjuna Singanayagam: Liver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK; Hepatology Department, Imperial College London, St. Mary’s Hospital, London, UK
Royce P. Vincent: Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
Evangelos Triantafyllou: Liver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK; Hepatology Department, Imperial College London, St. Mary’s Hospital, London, UK
Yun Ma: Liver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK
William Bernal: Liver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK
Georg Auzinger: Liver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK
Michael Heneghan: Liver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK
Charalambos Antoniades: Liver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK; Hepatology Department, Imperial College London, St. Mary’s Hospital, London, UK
Mirjam Christ-Crain: Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
Mark J.W. McPhail: Liver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK
David R. Taylor: Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
Julia Wendon: Liver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK
Christine Bernsmeier: Department of Biomedicine, University of Basel and University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland; Liver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK

Journal volume & issue: Vol. 2, no. 1
pp. 72 – 82

Abstract

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Background and Aims: The clinical, prognostic, and therapeutic impact of adrenal insufficiency in acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) remains controversial and exact diagnostic criteria are lacking. We sought to determine the diagnostic and therapeutic value of cortisol measurement and glucocorticoid (GC) treatment in ALF and ACLF. Methods: 28-day transplant-free survival (TFS) was studied in relation to absolute cortisol concentrations and to GC treatment in ALF (n = 30) and ACLF (n = 34) patients. Cortisol concentrations and short synacthen test were assessed by chemiluminescence immunoassay and liquid chromatography-mass spectrometry. Clinicians decided independently on GC treatment. In relation, phenotypic and functional characteristics of circulating monocytes were assessed. Results: In ALF, baseline cortisol concentrations <387 nmol/L predicted TFS (sensitivity 83%, specificity 53%). In ACLF, baseline cortisol <392 nmol/L correlated with TFS (sensitivity 80%, specificity 61%). In both, ALF and ACLF, GC treatment did not influence 28-day TFS in patients with low baseline cortisol. However, in patients with baseline cortisol exceeding 387 and 392 nmol/L, respectively, TFS was higher if they had been treated with GC. High baseline cortisol was associated with low HLA-DR expression on monocytes. Conclusion: Our data suggest a prognostic value of baseline cortisol measurement in ALF and ACLF. Overall, strong activation of the hypothalamic–pituitary–adrenal axis indicated poor prognosis. Furthermore, baseline cortisol deserves prospective evaluation as a guide for GC treatment decision-making.

Published in Gastro Hep Advances

ISSN: 2772-5723 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the digestive system. Gastroenterology
Website: https://www.sciencedirect.com/journal/gastro-hep-advances

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