The Serum Cortisol Levels Is Associated With Severity Of Liver Disease In Patients With HBV-related Acute On Chronic Liver Failure

Objective: To determine the levels of cortisol in peripheral blood of patients with HBV-related acute on chronic liver failure(HBV-ACLF),and to determine the correlation between cortisol levels and the prognosis of patients with HBV-ACLF.Methods: This study was carried out in Hepatology Department of The First Affiliated Hospital of Xinjiang Medical University,from January 2016 to November 2016.30 patients diagnosed with HBV-related acute on chronic liver failure,12 severe chronic hepatitis B,20 normal healthy people were enrolled in this study.Serum cortisol concentration at 10:00a.m,6:00p.m and 2:00 a.m were assessed.Furthermore,liver function,coagulation function and other related laboratory indexes were also determined.Results: The rate of adrenal insufficiency was 43%(13/30)in the HBV related acute on chronic liver failure group.The level of cortisol at at 2 a.m in HBV-ACLF group,severe CHB group,normal group were(161.32 ± 104.18),(93.53 ± 54.33),(19.06 ± 8.11)nmol/L,respectively.A decreasing trend was observed and the differences among groups were statistically significant(F=20.65,P<0.01).The level of cortisol at 2 a.m in patients with HBV-ACLF was inversely correlation with PTA(r=-0.383,P<0.05),and positively correlation with INR(r=0.406,P<0.05),MELD score(r=0.421,P<0.05).Association with TBiL,AST and ALT was no t observed.The level of cortisol at 2 a.m in survival group of HBV-ACLF were significantly higher than that in death group(t=2.33,P<0.05).The area under ROC survival curve was 0.763,there was statistically significant(P<0.05).Conclusion: The patients with HBV-ACLF had neuroendocrine immune system changes and a high incidence of adrenal insufficiency.Cortisol levels at 2 a.m increased in patients with HBV-ACLF which may related to severity of liver disease and play a role in the the prognosis of patients with liver failure.