Table 3.
Impact of serum total cortisol on the risk of (i) bacterial infections, (ii) decompensation/further decompensation, (iii) acute-on-chronic liver failure (ACLF) and (iv) liver-related death.
| Parameter of interest | Univariate (unadjusted) analysis | Multivariate (adjusted) analysis | ||||
|---|---|---|---|---|---|---|
|
sHR |
95% CI |
p value |
asHR |
95% CI |
p value |
|
| (i) Bacterial infections | ||||||
| Serum total cortisol, μg/dl∗ | 1.08 | 1.01–1.15 | 0.022 | 1.11 | 1.04–1.19 | 0.002 |
| Age, 10 years | 1.16 | 0.88–1.53 | 0.300 | — | — | — |
| Sex (male) | 1.14 | 0.52–2.50 | 0.740 | — | — | — |
| Child Turcotte Pugh score, points | 1.09 | 0.93–1.28 | 0.310 | — | — | — |
| Creatinine, mg/dl | 4.70 | 2.59–8.52 | <0.001 | 4.55 | 2.57–8.07 | <0.001 |
| Sodium, mmol/L | 0.99 | 0.88–1.14 | 0.970 | — | — | — |
| HVPG, mmHg | 1.02 | 0.97–1.08 | 0.420 | — | — | — |
| C–reactive protein, mg/dl |
1.29 |
1.02–1.64 |
0.036 |
1.26 |
0.98–1.61 |
0.072 |
| (ii) Decompensation/further decompensation | ||||||
| Serum total cortisol, μg/dl∗ | 1.06 | 1.01–1.12 | 0.019 | 1.08 | 1.02–1.12 | 0.008 |
| Age, 10 years | 0.88 | 0.69–1.13 | 0.330 | — | — | — |
| Sex (male) | 0.95 | 0.54–1.66 | 0.850 | — | — | — |
| Child Turcotte Pugh score, points | 1.30 | 1.16–1.47 | <0.001 | 1.08 | 0.92–1.27 | 0.330 |
| Creatinine, mg/dl | 2.88 | 1.72–4.81 | <0.001 | 2.19 | 1.12–4.26 | 0.021 |
| Sodium, mmol/L | 0.88 | 0.82–0.95 | <0.001 | 0.90 | 0.83–0.98 | 0.009 |
| HVPG, mmHg | 1.13 | 1.08–1.18 | <0.001 | 1.09 | 1.03–1.16 | 0.003 |
| C–reactive protein, mg/dl |
1.60 |
1.31–1.97 |
<0.001 |
1.30 |
1.03–1.67 |
0.031 |
| (iii) ACLF | ||||||
| Serum total cortisol, μg/dl∗ | 1.10 | 1.04–1.18 | 0.001 | 1.11 | 1.04–1.19 | 0.002 |
| Age, 10 years | 1.09 | 0.83–1.44 | 0.540 | — | — | — |
| Sex (male) | 1.26 | 0.58–2.75 | 0.560 | — | — | — |
| Child Turcotte Pugh score, points | 1.26 | 1.09–1.47 | 0.002 | 1.27 | 1.07–1.51 | 0.005 |
| Creatinine, mg/dl | 4.22 | 2.25–7.89 | <0.001 | 4.03 | 2.12–7.64 | <0.001 |
| Sodium, mmol/L | 0.95 | 0.85–1.06 | 0.320 | — | — | — |
| HVPG, mmHg | 1.03 | 0.98–1.09 | 0.220 | — | — | — |
| C–reactive protein, mg/dl |
1.23 |
0.95–1.58 |
0.110 |
— |
— |
— |
| (iv) Liver–related death | ||||||
| Serum total cortisol, μg/dl∗ | 1.08 | 1.01.–1.15 | 0.037 | 1.09 | 1.01–1.18 | 0.045 |
| Age, 10 years | 1.10 | 0.78–1.55 | 0.590 | — | — | — |
| Sex (male) | 1.34 | 0.53–3.40 | 0.540 | — | — | — |
| Child Turcotte Pugh score, points | 1.28 | 1.09–1.51 | 0.002 | 1.25 | 1.03–1.52 | 0.026 |
| Creatinine, mg/dl | 3.20 | 1.29–7.96 | 0.012 | 3.03 | 1.23–7.42 | 0.016 |
| Sodium, mmol/L | 0.98 | 0.91–1.06 | 0.630 | — | — | — |
| HVPG, mmHg | 1.06 | 0.99–1.13 | 0.069 | 1.03 | 0.95–1.11 | 0.500 |
| C–reactive protein, mg/dl | 1.27 | 0.92–1.76 | 0.140 | — | — | — |
Univariate and multivariate multivariate competing risk regression models are shown. Liver transplantation and death were considered as competing risks for (i) and (iii), while liver transplantation and non-liver-related death were considered as competing risks for (ii) and (iv). Adjusted subdistribution hazard ratio (asHR) with 95% confidence interval (95% CI) and significance levels of multivariate Fine and Gray competing risk regression models for serum total cortisol: (i) asHR: 1.11 (95% CI: 1.04–1.19), p = 0.002; (ii) asHR: 1.08 (95% CI: 1.02–1.12), p = 0.008; (iii) asHR: 1.11 (95% CI: 1.04–1.19), p = 0.002; (iv) asHR: 1.09 (95% CI 1.01–1.18), p = 0.045. Statistically significant values are provided in bold.
Indicated as a continuous variable from higher to lower serum total cortisol levels.