{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T16:00:39Z","timestamp":1792166439226,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,2,10]],"date-time":"2015-02-10T00:00:00Z","timestamp":1423526400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100011995","name":"Fundaci\u00f3 Investigaci\u00f3 Sant Pau","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100011995","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Relative adrenal insufficiency (<jats:styled-content style=\"fixed-case\">RAI<\/jats:styled-content>) is common in critical illness and in cirrhosis, and is related with worse outcomes. The prevalence of <jats:styled-content style=\"fixed-case\">RAI<\/jats:styled-content> may be different in variceal and non\u2010variceal bleeding and whether it may influence outcomes in these settings is unclear. This study assesses <jats:styled-content style=\"fixed-case\">RAI<\/jats:styled-content> and its prognostic implications in cirrhosis with variceal bleeding and in peptic ulcer bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with severe bleeding (systolic pressure &lt;100\u00a0mmHg and\/or haemoglobin &lt;8\u00a0g\/L) from oesophageal varices or from a peptic ulcer were included. Adrenal function was evaluated within the first 24\u00a0h and <jats:styled-content style=\"fixed-case\">RAI<\/jats:styled-content> was diagnosed as delta cortisol &lt;250\u00a0nmol\/L after 250\u00a0\u03bcg of i.v. corticotropin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty\u2010two patients were included, 36 had cirrhosis and variceal bleeding and 26 without cirrhosis had ulcer bleeding. Overall, 15 patients (24%) had <jats:styled-content style=\"fixed-case\">RAI<\/jats:styled-content>, 8 (22%) with variceal and 7 (24%) with ulcer bleeding. Patients with <jats:styled-content style=\"fixed-case\">RAI<\/jats:styled-content> had higher rate of bacterial infections. Baseline serum and salivary cortisol were higher in patients with <jats:styled-content style=\"fixed-case\">RAI<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) while delta cortisol was lower (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). There was a good correlation between plasma and salivary cortisol (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). The probability of 45\u2010days survival without further bleeding was lower in cirrhotic patients with variceal bleeding and <jats:styled-content style=\"fixed-case\">RAI<\/jats:styled-content> than in those without <jats:styled-content style=\"fixed-case\">RAI<\/jats:styled-content> (25% vs 68%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02), but not in non\u2010cirrhotic patients with peptic ulcer bleeding with or without <jats:styled-content style=\"fixed-case\">RAI<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.75).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The prevalence of <jats:styled-content style=\"fixed-case\">RAI<\/jats:styled-content> is similar in ulcer bleeding and in cirrhosis with variceal bleeding. Cirrhotic patients with <jats:styled-content style=\"fixed-case\">RAI<\/jats:styled-content>, but not those with bleeding ulcers, have worse prognosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.12788","type":"journal-article","created":{"date-parts":[[2015,1,24]],"date-time":"2015-01-24T06:50:07Z","timestamp":1422082207000},"page":"1964-1973","source":"Crossref","is-referenced-by-count":12,"title":["Relative adrenal insufficiency in severe acute variceal and non\u2010variceal bleeding: influence on outcomes"],"prefix":"10.1111","volume":"35","author":[{"given":"Isabel","family":"Graupera","sequence":"first","affiliation":[{"name":"Gastrointestinal Bleeding Unit Department of Gastroenterology Hospital de la Santa Creu i Sant Pau Barcelona Autonomous University Barcelona Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd) Barcelona 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