Higher free serum cortisol is associated with worse survival in acute variceal bleeding because of cirrhosis

Abstract

Higher FC is present in cirrhosis with AVB compared with CC and is associated independently with bleeding-related mortality. However, whether high FC solely indicates the severity of illness or whether there is significant adrenal insufficiency cannot be discerned.

Should patients with cirrhosis and variceal hemorrhage receive glucocorticoid therapy?

“…Tsai et al found that the mean serum total cortisol level was 16.8 µg/dL for the whole group of patients. This value is consistent with cortisol levels of 24.3 µg/dL obtained by others in patients with cirrhosis and variceal hemorrhage or 16.8 µg/dL in critically ill patients without cirrhosis . Moreover, serum total cortisol levels measured by Tsai et al were well above those measured by others in patients with stable cirrhosis (11.6 µg/dL) or 11.9 µg/dL in healthy subjects .…”

“…This value is consistent with cortisol levels of 24.3 µg/dL obtained by others in patients with cirrhosis and variceal hemorrhage or 16.8 µg/dL in critically ill patients without cirrhosis . Moreover, serum total cortisol levels measured by Tsai et al were well above those measured by others in patients with stable cirrhosis (11.6 µg/dL) or 11.9 µg/dL in healthy subjects . Together these findings suggest that, like critically ill patients without cirrhosis, patients with cirrhosis and variceal hemorrhage have basal hypercortisolemia.…”

“…Triantos et al calculated serum free cortisol levels (using Coolen's formula) and measured salivary cortisol levels (surrogate for free cortisol level) in patients with cirrhosis who had or did not have variceal hemorrhage. 4 Median values of free and salivary cortisol levels were significantly higher in bleeders than in nonbleeders. Calculated free cortisol levels 3.2 mg/dL were independent predictors of 6-week mortality.…”

“…Median values of free and salivary cortisol levels were significantly higher in bleeders than in nonbleeders. Calculated free cortisol levels ≥3.2 µg/dL were independent predictors of 6‐week mortality …”

“…Critically ill patients without cirrhosis have a marked reduction in corticosteroid‐binding globulin and albumin levels with proportional increases in free cortisol. Triantos et al calculated serum free cortisol levels (using Coolen's formula) and measured salivary cortisol levels (surrogate for free cortisol level) in patients with cirrhosis who had or did not have variceal hemorrhage . Median values of free and salivary cortisol levels were significantly higher in bleeders than in nonbleeders.…”