{"id":1932,"date":"2011-10-01T01:00:00","date_gmt":"2011-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/un-taux-eleve-de-cortisol-libre-serique-predit-la-mortalite-a-12-mois-chez-des-patients-cirrhotiques-stables\/"},"modified":"2018-10-20T18:40:01","modified_gmt":"2018-10-20T16:40:01","slug":"un-taux-eleve-de-cortisol-libre-serique-predit-la-mortalite-a-12-mois-chez-des-patients-cirrhotiques-stables","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/un-taux-eleve-de-cortisol-libre-serique-predit-la-mortalite-a-12-mois-chez-des-patients-cirrhotiques-stables\/","title":{"rendered":"UN TAUX ELEVE DE CORTISOL LIBRE SERIQUE PREDIT LA MORTALITE A 12 MOIS CHEZ DES PATIENTS CIRRHOTIQUES \u00ab STABLES \u00bb."},"content":{"rendered":"<p><strong>2011<\/strong><\/p>\n<p><em>Thierry THEVENOT (1), Richard I. DORIN (2), Clifford R. QUALLS (3), B\u00e9atrice CLERC (1) Remy SAPIN (4), Emilie GRANDCLEMENT (5), Jean-Paul CERVONI (1), Blandine ALBY (1), Delphine WEIL (1), Thibault DEGAND (1), Elisabeth MONNET (1), Vincent Di MARTINO (1), Rasa KAZLAUSKAITE (6).<\/em><\/p>\n<p><strong>H\u00e9patologie <\/strong>&#8211; \u00a02011-05-15 &#8211;\u00a0CO &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Introduction: L\u2019\u00e9valuation de la fonction surr\u00e9nale utilise classiquement le dosage du cortisol total s\u00e9rique (CTS) qui surestime la pr\u00e9valence de l\u2019insuffisance surr\u00e9nale dans la cirrhose. Le but de cette \u00e9tude \u00e9tait (1) d\u2019explorer et de comparer le cortisol libre s\u00e9rique (CLS) mesur\u00e9 et le CLS \u00ab estim\u00e9 \u00bb en utilisant le test au Synacth\u00e8ne \u00e0 1 \u00b5g chez des patients cirrhotiques \u00ab stables \u00bb. L\u2019estimation du CLS \u00e9tait r\u00e9alis\u00e9e par la formule de Coolens et al. (J Steroid Biochem 1987) et par l\u2019\u00e9quation de Dorin et al. (Dorin et al. Clin Biochem 2009); (2) d\u2019explorer le CLS post-Synacth\u00e8ne comme pr\u00e9dicteur de la mortalit\u00e9 sans transplantation \u00e0 1 an.<br \/>\nM\u00e9thodes: Les dosage du CTS et du CLS \u00e9taient  r\u00e9alis\u00e9s \u00e0 0 (T0) et 30 (T30) minutes apr\u00e8s injection de 1 \u00b5g de Synacth\u00e8ne chez 95 patients cirrhotiques non infect\u00e9s (34 Child-Pugh A, 29 B, 32 C) et sans dysfonction surr\u00e9nale connue ou suspect\u00e9e. Le CLS \u00e9tait obtenu par ultrafiltration centrifugale puis dos\u00e9 par une m\u00e9thode radio-immunologique. La concordance entre les valeurs du CLS mesur\u00e9 et du CLS calcul\u00e9 avec les deux \u00e9quations \u00e9taient analys\u00e9e par la m\u00e9thode de Bland et Altman. Les courbes de survie \u00e9taient construites selon la m\u00e9thode de Kaplan-Meier et compar\u00e9es par le test du log-rank.<br \/>\nR\u00e9sultats: L\u2019\u00e2ge moyen \u00e9tait de 58\u00b110 ans, la cirrhose \u00e9tait d\u2019origine alcoolique (85%) et les hommes \u00e9taient majoritaires (69%). La dur\u00e9e moyenne du suivi des 90 patients non transplant\u00e9s \u00e9tait de 15.9\u00b16,5 mois et 17 patients d\u00e9c\u00e9daient (19%) 3.6\u00b12.8 mois apr\u00e8s l\u2019\u00e9valuation de leur surr\u00e9nale. Les patients Child C avaient des taux plus \u00e9lev\u00e9s de CLS \u00e0 T0 et \u00e0 T30, ind\u00e9pendamment des taux de CBG et d\u2019albumine. La formule de Coolens sous-estimait le CLS (biais \u00e0 45%; P&lt;0,001) surtout chez les patients ayant une albumin\u00e9mie basse, contrairement \u00e0 l\u2019\u00e9quation de Dorin (biais : 4%; P=0,14). Les patients d\u00e9c\u00e9d\u00e9s avaient 1) un score de MELD (22,6\u00b17,9 vs. 14\u00b15,8; P&lt;0,001) et des concentrations de CLS \u00e0 T30 (129\u00b167 vs. 94\u00b141 nmol\/L; P=0,02) plus \u00e9lev\u00e9s ; et 2) des concentrations plus faibles de CBG (29\u00b19 vs. 39\u00b114 mg\/L; P=0,007), d\u2019albumine (23\u00b16 vs. 31\u00b17 g\/L; P 79 nmol\/L \u00e9tait un facteur pr\u00e9dictif de d\u00e9c\u00e8s, ind\u00e9pendamment de l\u2019albumine et des scores de Child et de MELD. Les patients ayant un CLS \u00e0 T30 &gt; 79 nmol\/L (n=59) avaient une moins bonne survie que les autres patients (n=31).<br \/>\nConclusions: La formule de Coolens sous-estime le CLS, contrairement \u00e0 l\u2019\u00e9quation cubique d\u00e9velopp\u00e9e par Dorin et al. Chez le patient cirrhotique stable h\u00e9modynamiquement, des concentrations \u00e9lev\u00e9es de CLS sont associ\u00e9es \u00e0 un risque plus important de d\u00e9c\u00e8s \u00e0 1 an, et ce de fa\u00e7on ind\u00e9pendante des autres pr\u00e9dicteurs connus (score de Child, MELD et albumin\u00e9mie). Ce nouveau concept va \u00e0 l\u2019encontre de la th\u00e9orie du syndrome h\u00e9pato-surr\u00e9nalien.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2011 Thierry THEVENOT (1), Richard I. DORIN (2), Clifford R. QUALLS (3), B\u00e9atrice CLERC (1) Remy SAPIN (4), Emilie GRANDCLEMENT (5), Jean-Paul CERVONI (1), Blandine ALBY (1), Delphine WEIL (1), Thibault DEGAND (1), Elisabeth MONNET (1), Vincent Di MARTINO (1), Rasa KAZLAUSKAITE (6). H\u00e9patologie &#8211; \u00a02011-05-15 &#8211;\u00a0CO &#8211; ________________________________ Introduction: L\u2019\u00e9valuation de la fonction surr\u00e9nale [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[22],"class_list":["post-1932","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-22"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>UN TAUX ELEVE DE CORTISOL LIBRE SERIQUE PREDIT LA MORTALITE A 12 MOIS CHEZ DES PATIENTS CIRRHOTIQUES \u00ab STABLES \u00bb. - Abstracts des congr\u00e8s de l&#039;ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/un-taux-eleve-de-cortisol-libre-serique-predit-la-mortalite-a-12-mois-chez-des-patients-cirrhotiques-stables\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"UN TAUX ELEVE DE CORTISOL LIBRE SERIQUE PREDIT LA MORTALITE A 12 MOIS CHEZ DES PATIENTS CIRRHOTIQUES \u00ab STABLES \u00bb. - 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