NỒNG ĐỘ CORTISOL TOÀN PHẦN HUYẾT THANH Ở BỆNH NHÂN XƠ GAN CÓ NHIỄM TRÙNG DỊCH CỔ TRƯỚNG

Abstract

The prevalence of infections in cirrhotic patients ranges from 25% to 35%¹. The in-hospital mortality rate among cirrhotic patients with infection is approximately 15%, which is twice as high as that of cirrhotic patients without infection. Objective: To investigate the serum total cortisol concentration in cirrhotic patients with spontaneous bacterial peritonitis (SBP). Subjects and Methods: A retrospective cross-sectional descriptive study was conducted on 41 cirrhotic patients diagnosed with SBP according to the Atlanta 2012 criteria². The study was carried out at Hanoi Medical University Hospital and the Gastroenterology Center, Bach Mai Hospital, from August 2024 to June 2025. Results: The median serum total cortisol concentration at 8 a.m. was 271.50 µg/dL, which was lower than the diagnostic threshold for adrenal insufficiency in cirrhotic patients (<275 nmol/L), as defined by the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) 2017. The median MELD-Na score in the study cohort was 21. The median values of peripheral blood leukocyte count and high-sensitivity C-reactive protein (hs-CRP) were 6.48 G/L and 9.05 mg/L, respectively. ROC curve analysis of the 8 a.m. cortisol index for discriminating SBP revealed an area under the curve (AUC) of 0.27. These findings indicate that cortisol levels have limited diagnostic value in predicting spontaneous bacterial peritonitis in this patient population. Conclusion: Serum total cortisol concentration may serve as an indicator of adrenal insufficiency in cirrhotic patients; however, it does not demonstrate predictive value for spontaneous bacterial peritonitis in this study population.