The Change Of Serum Cortisol Concentration And Its Clinical Significance In Patients With Acute-on-chronic Liver Failure

Purpose:Liver failure as a common clinical serious syndrome is an important stressor to the body.There are many researches on the state of stress during the development and progression of liver failure,however,the study of changes in stress hormone levels in the disease state is very inadequate.As an important indicator to effectively respond to the body's stress state,the study of the changes of stress hormones in the body are extremely necessary.This article aims to explore the relationship between serum cortisol concentrations and the severity and prognosis of patients withacute-on-chronic liver failure by testing changes in serum cortisol levels after admission in patients with acute-on-chronic liver failure.And it will also provide a basis for the use of glucocorticoids in clinical treatment of patients with acute-on-chronic liver failure.Methods:From February 1st,2017 to August 1st,2017,19 patients with acute-on-chronic liver failure were selected as the test group who were treated in the Department of Infectious Diseases of the First Affiliated Hospital of Shanxi Medical University.At the same time,we select 20 healthy normal people as the control group.We collected serum cortisol at 8:00 AM on the second day after admission,collected serum cortisol at 8:00AM after 7 days of treatment,and other laboratory parameters?WBC,TB,CRE,ALT,AST,ALB,INR,PTA?,and calculated the MELD score before and after treatment,and we compare thesed these data.The correlations between laboratory indicators?WBC,TB,CRE,ALT,AST,ALB,INR,PTA?and MELD scores and serum cortisol were also analyzed.Results:The incidence of RAI in patients with acute-on-chronic liver failure before treatment was 21.05%?4/19?,and the incidence of RAI in patients with acute-on-chronic liver failure after acute treatment was 47.37%?9/19?.The cortisol levels before and after treatment of patients with acute-on-chronic liver failure and healthy controls were?469.74±231.01?nmol/L,?334.35±251.96?nmol/L,and?376.60±66.66?nmol/L.Patients with acute-on-chronic liver failure had significantly lower levels of cortisol after treatment than before treatment,and the differences were statistically significant?t=3.308,P<0.05?.Patients with acute-on-chronic liver failure had higher cortisol levels before treatment than healthy controls,and patients with acute-on-chronic liver failure had lower cortisol levels after treatment than those in healthy controls,with no statistically significant difference(t_{before treatment}=1.692,t_{after treatment}=-0.708,P>0.05).According to the MELD scores,the patients with acute-on-chronic liver failure were divided into MELD<40 group and MELD?40 group.Cortisol levels?the patients before treatment?in thetwo groups were?406.32±62.31?nmol/L and?540.22±85.49?nmol/L,respectively,and the difference was not statistically significant?t=1.266,P>0.05?.Cortisol levels?the patients after treatment?in the two groups were?147.36±40.87?nmol/L and?518.21±139.73?nmol/L,respectively,and the difference was not statistically significant?t=2.440,P>0.05?.Cortisol levels positively correlated with MELD score,TB,PTA in patients with acute liver failure before treatment(r_MELD=0.552,r_TB=0.467,r_PTA=0.516,P<0.05),and there is no significant correlation with WBC,CRE,ALT,AST,ALB,INR?P>0.05?.Conclusion:The serum cortisol concentration in patients with acute-on-chronic liver failure before treatment was significantly higher than that after 7 days of treatment.With the progress of treatment and disease,the incidence of RAI in patients with acute-on-chronic liver failure is significantly higher.The higher the serum cortisol level in acute-on-chronic liver failure patients,the heavier the disease and the worse the prognosis.