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Dehydroepiandrosterone sulfate and dehydroepiandrosterone sulfate/cortisol ratio in cirrhotic patients with septic shock: another sign of hepatoadrenal syndrome?
Tsai, Ming-Hung; Huang, Hui-Chun; Peng, Yun-Shing; Chen, Yung-Chang; Tian, Ya-Chung; Yang, Chih-Wei; Lien, Jau-Min; Fang, Ji-Tseng; Wu, Cheng-Shyong; Hsieh, Sen-Yung; Lee, Fa-Yauh.
Afiliação
  • Tsai MH; Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
  • Huang HC; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veteran General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.
  • Peng YS; Faculty of Medicine, Yang-Ming University School of Medicine, Taipei, Taiwan.
  • Chen YC; Division of General Medicine, Department of Medicine, Taipei Veteran General Hospital, Taipei, Taiwan.
  • Tian YC; Division of Endocrinology, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.
  • Yang CW; Chang Gung University, Taoyuan, Taiwan.
  • Lien JM; Chang Gung University, Taoyuan, Taiwan.
  • Fang JT; Division of Critical Care Nephrology, Kidney Institute, Chang Gung Memorial Hospital, Taipei, Taiwan.
  • Wu CS; Chang Gung University, Taoyuan, Taiwan.
  • Hsieh SY; Division of Critical Care Nephrology, Kidney Institute, Chang Gung Memorial Hospital, Taipei, Taiwan.
  • Lee FY; Chang Gung University, Taoyuan, Taiwan.
Crit Care ; 21(1): 214, 2017 Aug 15.
Article em En | MEDLINE | ID: mdl-28810889
ABSTRACT

BACKGROUND:

Cirrhotic patients are susceptible to sepsis and critical illness-related corticosteroid insufficiency (CIRCI). Dehydroepiandrosterone sulfate (DHEAS) is a corticotropin-dependent adrenal androgen, which has immunostimulating and antiglucocorticoid effects. Considering the synchronized synthesis of cortisol and DHEAS and their opposing effects to each other, investigators have proposed measuring these two hormones as a ratio. Severe sepsis has been associated with low DHEAS, especially relative to high cortisol. Despite growing interest in the role of adrenal androgen replacement in critical illness, there have been no data about DHEAS and the DHEAS/cortisol ratio in patients with liver cirrhosis. We studied whether low concentrations of DHEAS and decreased DHEAS/cortisol ratio are associated with poor outcome in patients with liver cirrhosis and septic shock.

METHODS:

We recruited 46 cirrhotic patients with septic shock, and 46 noncirrhotic counterparts matched by age and sex. We evaluated adrenal function using the short corticotropin stimulation test and analyzed the relation between DHEAS and cortisol.

RESULTS:

While the nonsurvivors in the cirrhotic group had significantly lower baseline DHEAS, lower baseline DHEAS/cortisol ratio, and reduced increments of both DHEAS and cortisol upon corticotropin stimulation, the survivors had lower baseline cortisol. Cirrhotic patients with lower DHEAS/cortisol ratio (<1.50) had higher levels of interleukin-6 and tumor necrosis factor alpha, higher Sequential Organ Failure Assessment scores, and higher rates of CIRCI and hospital mortality. Using the area under the receiver operating characteristic (AUROC) curve, both DHEAS and the DHEAS/cortisol ratio demonstrated a good discriminative power for predicting hospital survival (AUROC 0.807 and 0.925 respectively). The cirrhotic group had lower DHEAS and DHEAS/cortisol ratio but higher rates of CIRCI and hospital mortality, compared to the noncirrhotic group.

CONCLUSIONS:

There is dissociation between cortisol (increased) and DHEAS (decreased) in those cirrhotic patients who succumb to septic shock. Low DHEAS/cortisol ratios are associated with more severe diseases, inflammation, and CIRCI and can serve as a prognostic marker. More investigations are needed to evaluate the role of adrenal androgen in this clinical setting.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Choque Séptico / Hidrocortisona / Sulfato de Desidroepiandrosterona / Quimioterapia Combinada Tipo de estudo: Prognostic_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Crit Care Ano de publicação: 2017 Tipo de documento: Article País de afiliação: Taiwan

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Choque Séptico / Hidrocortisona / Sulfato de Desidroepiandrosterona / Quimioterapia Combinada Tipo de estudo: Prognostic_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Crit Care Ano de publicação: 2017 Tipo de documento: Article País de afiliação: Taiwan