Evidence map›Paper›PMID 39130154›Full record

ArticleGastro hep advances2023

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 and 7 more

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Article in Gastro hep advances, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

17 authors.

Sofia RothDepartment of Biomedicine, University of Basel and University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland.
Emilio FlintDepartment of Biomedicine, University of Basel and University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland.
Lea GhataoreDepartment of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK.
Vishal C PatelLiver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK.
Arjuna SinganayagamLiver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK.
Royce P VincentDepartment of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK.
Evangelos TriantafyllouLiver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK.
Yun MaLiver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK.
William BernalLiver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK.
Georg AuzingerLiver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK.
Michael HeneghanLiver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK.
Charalambos AntoniadesLiver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK.
Mirjam Christ-CrainDepartment of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland.
Mark J W McPhailLiver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK.
David R TaylorDepartment of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK.
Julia WendonLiver Intensive Therapy Unit and Institute of Liver Studies, King's College London, King's College Hospital, London, UK.
Christine BernsmeierDepartment of Biomedicine, University of Basel and University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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.

Indexed as

Acute-on-chronic liver failure (ACLF)Adrenal insufficiency (AI)Critical illness-related corticosteroid insufficiency (CIRCI)HLA-DR

Identifiers

PMID39130154
PMCPMC11308052

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.