الفهرس 
Introductionيوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Background: chronic liver disease and decompensated cirrhosis are associated with serious complications; spontaneous bacterial peritonitis is considered one of them that may lead to sepsis and adrenal insufficiency. Aim of the Work: Study the role of dehydroepiandrosterone sulfate (DHEAS) and dehydroepiandrosterone sulfate/cortisol ratio for evaluation of adrenal function in cirrhotic patients and as a possible prognostic factor in cirrhotic patients with spontaneous bacterial peritonitis. Patients and Methods: It was a prospective cohort study carried out on 100 patients in the internal medicine department. Tanta University hospital in the period from June 2021 to July 2022. divided into 2 studied patients groups: - • group (I): 50 patients with liver cirrhosis and sterile ascites. • group (II): 50 patients with liver cirrhosis and spontaneous bacterial peritonitis We evaluated adrenal function using Serum cortisol levels (9 A.M, 9 P.M and Post synacthen stimulation test) Dehydroepiandrosterone sulfate (DHEAS) level, and Dehydroepiandrosterone sulfate/cortisol ratio Results: The cirrhotic patients with spontaneous bacterial peritonitis have significantly lower Dehydroepiandrosterone sulfate (DHEAS), lower DHEAS/cortisol ratio, and high cortisol level post stimulation compared with patients with sterile ascites, Cirrhotic patients with lower DHEAS/cortisol ratio (<0.65) had higher levels of C- reactive protein (CRP), higher MELD score and Child-Pugh score had higher hospital mortality. Using the area under the receiver operating characteristic (AUROC) curve, both DHEAS and the DHEAS/cortisol ratio demonstrated a good discriminative power for predicting hospital survival (AUROC 0.267 and 0.298 respectively). The cirrhotic patients with spontaneous bacterial peritonitis had lower DHEAS and DHEAS/cortisol ratio but higher hospital mortality, compared to the cirrhotic patients with sterile ascites. Conclusions: In cirrhotic patients with spontaneous bacterial peritonitis There is a dissociation between cortisol (increased) and Dehydroepiandrosterone sulfate DHEAS (decreased). Low Dehydroepiandrosterone sulfate /cortisol ratios are presented in severe diseases and are associated with higher mortality. This ratio may serve as a prognostic marker.