title: Adrenal function and microbial DNA in noninfected cirrhotic patients with ascites: Relationship and effect on survival.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  The aim of this study was to evaluate prognostic role of adrenal dysfunction, microbial DNA, and their relationship.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 r=0.5107; p=0.018).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology and Hepatology, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy. Electronic address: risso.ale@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Risso
authors.affiliation: Division of Gastroenterology and Hepatology, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Alessandria
authors.affiliation: Division of Gastroenterology and Hepatology, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Mezzabotta
authors.affiliation: Division of Gastroenterology and Hepatology, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Elia
authors.affiliation: Division of Gastroenterology and Hepatology, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Alida
authors.initials: A
authors.lastname: Andrealli
authors.affiliation: Division of Gastroenterology and Hepatology, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Spandre
authors.affiliation: Division of Gastroenterology and Hepatology, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Di Luigi
authors.affiliation: Laboratory of Microbiology, Department of Clinical Pathology, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Barbui
authors.affiliation: Unit of Cancer Epidemiology, CPO Piemonte, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Division of Gastroenterology and Hepatology, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Morgando
authors.affiliation: Laboratory of Microbiology, Department of Clinical Pathology, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Serra
authors.affiliation: Unit of Cancer Epidemiology, CPO Piemonte, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
authors.affiliation: Division of Gastroenterology and Hepatology, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Marzano
authors.affiliation: Division of Gastroenterology and Hepatology, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood* / Q000150:complications; D000368:Aged; D001201:Ascites / Q000209:etiology / Q000378:metabolism / Q000382:microbiology; D004269:DNA, Bacterial / Q000097:blood* / Q000378:metabolism; D004271:DNA, Fungal / Q000097:blood* / Q000378:metabolism; D058625:End Stage Liver Disease / Q000097:blood* / Q000209:etiology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000401:mortality*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015996:Survival Rate
chemical_list: D004269:DNA, Bacterial; D004271:DNA, Fungal; D006854:Hydrocortisone
keywords: Adrenal insufficiency; Ascites; Bacterial DNA; Cirrhosis