RESULTS

The study was conducted in the Department of Medicine, Pt. B.D.

Sharma PGIMS, Rohtak. 132 patients with documented cirrhosis
were included to be a part of the study. Out of 132 patients, 11
patients were in shock , 2 patients were diagnosed with SBP, 6
patients had documented sepsis and 13 patients did not gave
consent for the study. Consequently, 100 patients of cirrhosis were
finally taken in this study. Patients were then categorised into 3
groups on the basis of Child-Turcotte-Pugh score and were labelled
as group I, II and III for CTP class A,B and C respectively. The
process of selection and enrollment of the study participants is

depicted in fig no 1-

Figure 1 - Selection and enrollment of study participants.

Demographic profile of patients

7 6 of the study participants were males and females constituted

24 of total study participants (M:F-3.15) . The mean age of the
study participants was 46.5 years +11.316 years, the distribution
has been shown in table 1, figure 2.

Table 1: Demographic profile of subjects (N=100).

Gender Number
Male 76
Female 24
M: F 3.15

Age ( In Years ) (mean+-SD) 46.55 + 11.3

Figure 2- Pie chart demonstrating gender wise distribution of study

participants

Male
Female
Etiology of cirrhosis in study subjects (n=100)

The etiology of cirrhosis has been described in table 2. The primary

etiology of cirrhosis among the study subjects was alcohol use,
accounting for 64% of the cases. Hepatitis C was the second most
common cause of cirrhosis, contributing 13% of the total cases,
followed by autoimmune etiology (9%), non alcoholic
steatohepatitis (7%) and hepatitis B (5%). HVOTO was relatively
uncommon causes of cirrhosis, constituting 1% of the cases. No
etiology was found in 1 patient, thus was labelled as cryptogenic
cirrhosis.

Table 2: Etiology of cirrhosis in study subjects (N=100).

Etiology No of patients (%)

Alcohol 64
Autoimmune 9
HVOTO 1
Hepatitis B 5
Hepatitis C 13
NASH 7
Cryptogenic 1

Figure 3: Etiology of cirrhosis in study subjects (N=100)

Etiology of cirrhosis in study subjects

70
64

60

50

40

30

20
13
9
10 7
5
1 1
0
Alcohol Autoimmune Hvoto Hepatitis B Hepatitis C NASH Cryptogenic
 CTP score in study subjects (N=100)

In terms of CTP score distribution, 42% subjects were classified

under CTP score B, 37% under CTP score C and 21% under CTP score
A. (B>C>A) as shown in table 3

Table 3: CTP score wise age distribution of study subjects (N=100).

CTP score No of patients (%)

A 21
B 42
C 37
Total 100

CTP score wise age distribution of study subjects

45
42
40
37
35

30

25
21
20

15

10

0
A B C

Figure 4: CTP score wise distribution of study subjects

MELD score in study subjects

When the study participants were distributed according to Model for End-Stage Liver disease
(MELD), 64% population had MELD score between 11-20, 19% had scores between 1-10, followed
by 15% patients with score >20. This data has been described in table 4.
MELD score No of patients (%)
1-10 19
11-20 64
>20 15

Table 4: MELD score wise distribution of study subjects.

MELD score wise distribution of study subjects.

70
64

60

50

40

30

19
20
15

10

0
1-10 11-20 >20

Figure 5- Diagrammatic representation of MELD score wise distribution of study subjects

Baseline parameters in all patients.

Several baseline parameters were assessed across three groups:

• Haemoglobin levels depicted significant differences among the groups, with Group I having the
highest mean (11.58 ± 2.52 g/dL), followed by Group II (9.05 ± 2.27 g/dL) and Group III (8.87 ±
2.38 g/dL). The P-value for haemoglobin differences between I vs II and I vs III was <0.001,
indicating a significant drop in haemoglobin levels in parallel to disease severity. However no
statistically significant difference was found between group II and III (p=0.687)

• TLC (Total Leukocyte Count) and Platelet count did not show statistically significant
differences among the groups (p-values of 0.228 and 0.569 respectively).

• Regarding renal function test, Blood Urea and Serum Creatinine also demonstrated no significant
differences among the 3 groups (p-values of 0.866 and 0.736 respectively).
• Prothrombin Time showed statistically significant increase in more severe disease groups (p-
values <0.001) in comparison between group I vs II, I vs III, however no significance was observed
among group II vs III (p=0.686). Similarly international normalised ratio observed statistically
significant difference among group I vs II and I vs III with a p value of <0.001, however
comparison between group II vs III depicted no significant results (p=0.044).

• Total Bilirubin, Direct Bilirubin, and Indirect Bilirubin levels were significantly raised in more
severe disease groups (p-values <0.001) while comparing group II vs III and I vs III, However,
the results were comparable when group I vs II were compared.(p= 0.337, 0.476 and 0.310)
respectively in terms of total bilirubin , direct bilirubin and indirect bilirubin.

• Liver Enzymes (Aspartate transaminase and Alanine transaminase) did not show
significant differences. (P=0.071 and 0.646 respectively)

• Alkaline Phosphatase also showed no significant difference (p=0.755)

• No statistically significant differences were found in serum protein with a p value of 0.139,
however differences were significant w.r.t. serum albumin while comparing group I vs II, II vs III
and I vs III (p<0.001, <0.001 and 0.007) respectively.

The baseline clinical parameters have been tabulated as table 5:

Table 5- Baseline parameters in all study participants (N=100)

Variable I(n=21) II(n=42) III(n=37) p-value# I vs II$ I II

vs vs
III$ III$
Haemoglobin 11.58 + 9.047 + 8.87 + 2.38 <0.001* 0.001* <0.001 0.687
(g/dl) 2.52 2.27 *
TLC 6337 6652.38 7425.43 0.228 - - -
(/cumm) +2948.69 +2202.064 +2464.879
Platelet 1.038 + 1.15 + 1.10 + 0.458 0.569 - - -
s 0.43 0.38
(/cumm
)
Blood 24.29 + 24.88 + 25.54 + 0.866 - - -
urea 9.06 8.57 8.565
(mg/dl)
Serum 0.85 + 0.87 + 0.84 + 0.17 0.736 - - -
creatinine 0.17 0.18
(mg/dl)
Prothrombin 17.31 + 19.31 27.25+12.27 <0.001* <0.001 <0.001 0.686
Time 4.78 +6.08 * *
 INR 1.27 + 1.53 + 2.23 + 1.03 <0.001* <0.001 <0.001 0.044
0.28 0.30 * * *
Total 1.5 + 2.05 + 3.22 + 1.579 <0.001* 0.337 <0.001 0.001
Bilirubin 0.65 1.18 * *
mg/dl)
Direct 0.61 + 0.82 + 1.33 + 0.648 <0.001* 0.476 <0.001 0.001
Bilirubin 0.29 0.48 * *
(mg/dl)
Indirect 0.895 + 1.22 + 1.87 + 0.99 <0.001* 0.310 <0.001 0.007
Bilirubin 0.395 0.754 * *
(mg/dl)
Aspartate 66.19 + 73.38 + 76.76 + 0.071 - - -
transaminase 65.977 40.68 45.946
(U/L)
Alanine 51.62+ 40.83 + 35.43 + 0.646 - - -
transaminase 43.826 26.131 15.664
(U/L)
Alkaline 135.33 + 165.38 + 141.43 + 0.755 - - -
phosphatase 59.829 111.8 61.68
(U/L)
Serum 7.26 + 6.97 + 6.74 + 1.04 0.139 - - -
Protei 0.77 1.01
n
(g/dl)
Serum 3.98 + 3.09 + 2.68 + 0.50 <0.001* <0.001 <0.001 0.007
Albumi 0.5 0.427 * * *
n (g/dl)
#Kruskal wallis H test
$Post hoc analysis Dunn test

*Significant

Group wise adrenal insufficiency as per post- test cortisol levels

Table 6 describes the group wise adrenal insufficiency as per post-test cortisol levels as defined by
peak cortisol <18 mcg/dl. It was observed that that 89.19%(n=33) of patients in Group III had
adrenal insufficiency, followed by 52.38%(n=22) in Group II, and 23.81%(n=5) in Group
I(III>II>I).

Table 6: Group wise adrenal insufficiency as per post-test cortisol levels.

 Group No. of patients with Adrenal
insufficiency(60)
(%)
I 5 (23.81)
II 22 (52.38)
III 33 (89.19)

Adrenal insufficiency as per post test cortisol levels

33

22
20
16

5 4
I II III
Present Absent

Figure 6: Diagram showing group wise adrenal insufficiency as per post-test cortisol levels

Group vide adrenal insufficiency as per delta cortisol levels

Group wise adrenal insufficiency was evaluated as per delta cortisol levels less than 9 mcg/dl. It was
observed that 94.59%(n=35) of patients in group III had adrenal insufficiency, followed by 57.14%
(n=24) in group II and % in group I(n=10).The data has been tabulated in table 7.

Table 7: Group wise adrenal insufficiency as per delta cortisol levels.

Group Adrenal insufficiency present

(69) (%)
I 10 (47.62)
II 24 (57.14)
III 35 (94.59)
Adrenal insufficiency as per delta cortisol levels

35

24

18

10 11

2
I II III

Present Absent

Figure 7: Group wise adrenal insufficiency as per delta cortisol

Group wise comparison of cortisol levels among study participants ( Before SST)
Group wise comparison of serum cortisol levels among study participants were evaluated. It was
observed that mean serum cortisol level was higher in group I i.e., 14.73+7.04, followed by group II
(9.38+4.44)and group III (5.31+3.64). The difference was observed to be statistically significant (P-
value <0.001). on post hoc analysis, it was observed that difference between group I and II(P=0.045),
group I and III(P<0.001), II and III(P<0.001) was statistically significant.The description has been
elucidated in table 8.

Table 8: Group wise comparison of cortisol levels among study participants ( Before SST).

variable I(n=21) II(n=42) III(n=37) P-value I vs II I vs III II vs III

Serum 14.73 + 9.38 + 5.31 + <0.001* 0.045* <0.001* <0.001*
cortisol 7.04 4.44 3.64
(before
SST
)(mcg/
dl)

*Significant
.

Group wise comparison of cortisol levels among study participants ( After SST)

While describing the group wise comparison of serum cortisol levels (post test) among study
participants, It was observed that mean serum cortisol level was higher in group I i.e., 23.84+8,
followed by group II (17.85+5.73) and group III (11.92+8.92). The difference was observed to be
statistically significant (p-value <0.001). On post hoc analysis , it was observed that difference
between group I and III, II and III was statistically significant but the difference between I and II
was not statistically significant (p-value = 0.088).
The group wise comparison of cortisol levels among study participants after SST has been
elucidated below.

Table 9: Group wise comparison of cortisol levels among study participants. (After SST)

variable I(n=21) II(n=42) III(n=37) P-value I vs II I vs III II vs III

Serum 23.84 + 17.85 + 11.92 + <0.001* 0.088 <0.001* <0.001*
cortisol 8 5.73 8.92
(after
syntropic
test)

*Significant

Group wise comparison of pre-post values

Comparison of pre-post cortisol levels were assessed. It was observed that a statistically significant
difference was observed in pre-test and post-test values of serum cortisol with a p value of <0.001,
with lower level of serum cortisol observed in pre test(14.7+7.04, 9.38+-4.44 and 5.31+3.64 in
group I, II and III respectively) as compared to post-test(23.84+8.0, 17.85+5.73 and 11.9+8.9 in
group I, II and III respectively).the comparison between pre post cortisol levels are depicted below.

Table 10: Group wise comparison of pre-post cortisol levels.

Group Serum Serum P-value$

Cortisol Cortisol
(before) (after)
I 14.7 + 7.04 23.84 + 8.0 <0.001*

II 9.38 + 4.44 17.85 + 5.73 <0.001*

III 5.31 + 3.64 11.9 + 8.9 <0.001*

$Wilcoxon signed rank test

*Significant
 Group wise comparison of pre-post cortisol levels
23.84

17.85

14.7

11.9
9.38

5.31

I II III
Serum cortisol (Before) Serum Cortisol (After)

Figure 8: Diagram showing group wise comparison of pre-post cortisol level

Group wise comparison of cortisol levels among study participants (Delta cortisol)
Table 11 describes the group wise comparison of delta cortisol levels among study participants. It
was observed that mean serum delta cortisol level were higher in group I i.e., 9.25+4.39, followed by
group II (8.64+3,15) and group III (6.61+7.98). The difference was observed to be statistically
significant (P-value <0.001). On post hoc analysis , it was observed that difference between group I
and III, II and III was statistically significant but the difference between I and II was not statistically
significant (p-value = 1).

Table 11: Group wise comparison of cortisol levels among study participants.

variable I(n=21) II(n=42) III(n=37) p-value I vs II II vs III II vs III

Delta 9.25 + 8.64 + 6.61 + <0.001* 1 0.002* <0.001*

cortisol 4.39 3.15 7.98

*Significant
 Group wise adrenal insufficiency

Table 12 depicts the group wise adrenal insufficiency by taking into consideration two parameters

-Peak cortisol less than 18 mcg/dl

-Delta cortisol less than 9 mcg/dl.
It was observed that as per peak cortisol level, 89.19%(n=33) of participants in group III had
adrenal insufficiency, followed by group II (52.38%)(n=22)and group I (23.81%)(n=5). While
considering delta cortisol level as the diagnostic parameter, it was observed that 94.59%(n=35) of
participants in group III had adrenal insufficiency, followed by 57.14%(n=24) in group II and
47.62%(n=10) in group I.
Regarding overall adrenal insufficiency, following observations were elicited:
Overall, 73 patients met the criterion of adrenal insufficiency.

In group I overall adrenal insufficiency was demonstrated in 13.69% (N=10) with 5 patients
exhibiting overlap when comparing the two diagnostic modalities. 5 patients exhibited isolated delta
cortisol deficiency.
- In group II, there was an overall depiction of adrenal insufficiency in 36.99% (n=27) of the
patients, with 19 patients exhibiting overlap when comparing the two diagnostic modalities, 3
patients exhibiting isolated peak cortisol deficit, and 5 individuals eliciting isolated delta cortisol
deficiency.

- While comparing group III, combined adrenal insufficiency was demonstrated in 36 patients, 3
patients had isolated peak cortisol deficiency and 1 patients demonstrated isolated delta
cortisol deficiency

Table 12: Adrenal insufficiency as defined by the peak cortisol post SST (A) and delta cortisol (B)

Grou Adrenalinsufficiency Adrenal Adrenal Overall

p as per peak cortisol insufficienc insufficiency Adrenal

levels (A) y as per as per both Insuuficin

N= 60 delta peak ency

cortisol cortisol and (A/B/A+B

levels (B) delta )

N=69 cortisol N=73

levels (A+B)
N=56
I N=5 (23.81%) N=10 (47.62%) N=5 (8.93%) 10 (13.69)
II N=22 (52.38%) N=24 (57.14%) N=19 (33.93%) 27 (36.99)
III N=33 (89.19%) N=35 (94.59%) N=32 (57.14%) 36 (49.32)
‍
 36

27

15

10 11

1
A B C

a Present Absent

Figure 9 :Diagram showing group wise adrenal insufficiency as per all three parameters

Group Serum Serum p-value$

Cortisol Cortisol
(before) (after)
Table I 14.7 + 7.04 23.84 + 8.0 <0.001*

II 9.38 + 4.44 17.85 + 5.73 <0.001*

III 5.31 + 3.64 11.9 + 8.9 <0.001*

$Wilcoxon signed rank test

*Significant
 Univariate analysis of baseline characteristics among patients with AI and without AI in group A.

Table 13 describe the univariate analysis of baseline characteristics and presence of adrenal
insufficiency. It was observed that, values for TLC, Platelet, blood urea, indirect bilirubin, SGPT,
ALP, serum cortisol baseline, serum cortisol (post test) were higher among those with no adrenal
insufficiency as compared to those with adrenal insufficiency, with a statistically significant value of
p=0.005 in post cortisol value. The values for haemoglobin, serum creatinine, prothrombin time, total
bilirubin, indirect bilirubin, SGOT, ALP serum albumin and serum protein was higher among patients
with adrenal insufficiency as compared to those without insufficiency, but this difference was not
observed to be statistically significant.

Table 13: Univariate analysis of baseline characteristics among patients with AI and without AI in
group A.

Variable Adrenal Adrenal p-value$

insufficiency insufficiency absent
present(n=10) (n=11)
Haemoglobin(g/dl) 12.1 (11.425-13.25) 11.7 (8.5-13.5) 0.480
TLC(/cumm) 5826.5(4690-8655) 7231 (3900-9400) 0.944
Platelets(/cumm) 0.93 (0.6675-1.35) 14.9 (12.8-19) 0.944
Blood urea (mg/dl) 19 (15.25-25.75) 23 (21-35) 0.084
Serum 0.9 (0.675-1.025) 0.8(0.7-1) 0.643
creatinine
(mg/dl)
Prothrombin Time 18.4 (15.45-19.5) 14.9 (12.8-19) 0.191
INR 1.3 (1.1-1.4) 1.18 (0.96-1.6) 0.915
Total Bilirubin 1.5 (0.825-1.825) 1.4 (1.1-1.9) 0.750
(mg/ dl)
Direct Bilirubin (mg/ 0.55 (0.3-0.8) 0.6 (0.5-0.8) 0.620
dl)
Indirect 0.9 (0.55-1.05) 0.8 (0.5-1.3) 0.972
Bilirubin
(mg/dl)
SGOT (U/L) 44 (23.25-102) 41 (34-58) 0.672
 SGPT (U/L) 40.5 (26.75-59.5) 43 (22-55) 0.751
ALP (U/L) 124 (86.25-172) 112 (99-162) 0.888
Serum Protein (g/dl) 6.94 (6.375-8.05) 7.4 (7-7.9) 0.503
Serum Albumin 4 (3.65-4.45) 3.8 (3.6-4.6) 0.832
(g/ dl)
Serum cortisol 12.5 (6.98-12.5) 16.4 (11.4-18) 0.360
(baseline)(mcg/dl)

Serum cortisol (post- 18 (13.6-22.27) 27.4 (24.9-32.9) 0.005*

test)(mcg/dl)

MELD score 9.7 + 2.11 11.72 + 2.53 0.099

$Mann whitney U

Univariate analysis of baseline characteristics among patients with AI and without AI in group B

Univariate analysis of baseline characteristics and presence of adrenal insufficiency was evaluated.
It was observed that, values for Haemoglobin, TLC, Platelet, blood urea, Prothrombin time, total
bilirubin, direct bilirubin, indirect bilirubin, SGOT, SGPT, ALP, serum cortisol baseline, serum
cortisol (post-test) were higher among those with no adrenal insufficiency as compared to those
with adrenal insufficiency, but this difference was not observed to be statistically significant

except for SGOT, where the difference was statistically significant (p-value = 0.008), baseline serum
cortisol (p=0.003), and post test cortisol (p<0.001). The values for serum albumin and serum protein
was higher among patients with adrenal insufficiency as compared to those without insufficiency, but
this difference was not observed to be statistically significant.

Table 14: Univariate analysis of baseline characteristics among patients with AI and without group
B.
Variable Adrenal Adrenal p-value$
insufficiency insufficiency
present(n=27) absent(n=15)
Haemoglobin (g/dl) 8.6 (7.3-10.6) 9.2 (7.3-12.5) 0.512
TLC (/cumm) 6700 (4500-8200) 7230 (4800-8930) 0.259
Platelets (/cumm) 1.1 (0.79-1.3) 1.3 (0.91-1.6) 0.109
Blood urea (mg/dl) 22 (17-31) 27 (17-30) 0.916
Serum 0.9 (0.7-1) 0.9 (0.8-1.1) 0.317
creatinine
(mg/dl)
Prothrombin Time 18 (15-21) 19 (16.4-21) 0.937
INR 1.6 (1.3-1.8) 1.52 (1.2-1.6) 0.135
Total Bilirubin 1.7 (1.1-2.1) 2.4 (1.4-3.8) 0.055
(mg/ dl)
Direct Bilirubin (mg/ 0.7 (0.4-1) 1 (0.6-1.6) 0.067
dl)
Indirect 1 (0.7-1.27) 1.4 (0.8-2) 0.055
Bilirubin
(mg/dl)
SGOT (U/L) 49 (39-78) 82 (59-149) 0.008*
SGPT (U/L) 32 (23-42) 37 (26-97) 0.093
ALP (U/L) 117 (105-181) 142 (106-168) 0.854
Serum Protein (g/dl) 7.3 (6.6-7.7) 7.2 (5.9-7.4) 0.554
Serum Albumin 3.1 (2.9-3.4) 3 (2.6-3.6) 0.926
(g/dl)
Serum cortisol 7.9 (5.23-9.6) 11.8 (7.2-18.1) 0.003*
(baseline)(mcg/dl)
Serum cortisol (post- 14.7 (13.2-16.8) 21.1 (19.9-28.5) <0.001*
test)(mcg/dl)
MELD score 13.74 + 3.35 14.61 + 2.84 0.440

*Significant
$Mann whitney U
Univariate analysis of baseline characteristics among patients with AI and without AI in group C

There was only single patient with no adrenal insufficiency in group C. Hence the statistics could
not be computed for comparison of adrenal insufficiency present vs absent.

Univariate analysis of baseline characteristics among patients with AI and without AI in all
patients

Table 15 describes the univariate analysis between baseline characteristics and Adrenal
insufficiency. It was observed that the difference was statistically significant for Prothrombin
time(p=0.02), INR(p<0.001), serum albumin(0.004), serum cortisol (baseline)(<0.001), serum
cortisol (peak)(p<0.001), delta cortisol(p<0.001)and MELD score(p=0.023). The difference was
observed to be statistically non-significant for all other baseline parameters.
 Variable Adrenal Adrenal p-value
insufficiency insufficiency
present(n=73) absent(n=27)
Haemoglobin (g/dl) 9.29 + 2.47 10.1 + 2.81 0.152#
TLC (/cumm) 6903.62 + 2413.39 6787.44 + 2711.551 0.917
Platelets (/cumm) 1.09 + 0.41 1.16 + 0.42 0.475
Blood urea (mg/dl) 24.42 + 8.6 26.55 + 8.51 0.282
Serum 0.85 + 0.176 0.87 + 0.175 0.676
creatinine
(mg/dl)
Prothrombin Time 23.39 + 10.61 17.61 + 3.96 0.002*
INR 1.874 + 0.85 1.37 + 0.286 <0.001*
Total Bilirubin 2.4 + 1.44 2.28 + 1.41 0.655
(mg/ dl)
Direct Bilirubin 0.98 + 0.60 0.92 + 0.56 0.654
(mg/ dl)
Indirect 1.41 + 0.88 1.35 + 0.89 0.697
Bilirubin
(mg/dl)
SGOT (U/L) 66.81 + 39.619 90.19 + 64.637 0.233
SGPT (U/L) 36.88 + 22.554 52.52 + 37.883 0.109
ALP (U/L) 144.88 + 80.426 164.63 + 100.936 0.724
Serum Protein (g/dl) 6.91 + 0.98 7.04 + 1.01 0.583
Serum Albumin 3.01 + 0.6 3.44 + 0.71 0.004*#
(g/ dl)

Serum cortisol 7.33 + 5.26 13.5 + 5.31 <0.001*

(baseline)(mcg/dl)
Serum cortisol (post- 13.31 + 5.44 26.64 + 8.39 <0.001*
test)(mcg/dl)
Delta 5.98 + 2.18 13.51 + 8.2 <0.001*
cortisol(mcg/ dl)
MELD score 15.75 + 5.24 13.2 + 2.97 0.023

Table 15- Univariate analysis of baseline characteristics among patients with AI and without AI in
all patients

*Significant
#Independent sample t test
Mann Whitney U

Spearman rank correlation analysis among Group A.

Correlation between baseline characteristics and cortisol level in group I was evaluated. It was
observed that there was non-significant correlation between baseline characteristics and cortisol
level for all variables except for age(p=0.037) with peak cortisol level and blood urea(0.035) with
delta cortisol levels, where a statistically significant positive correlation was observed. The data has
been demonstrated in table 16.

Table 16: Spearman rank correlation analysis among Group A.

variable S. cortisol Delta

(after) r (p- cortisol r (p-
value) value)
Age (years) -0.457 (0.037*) -0.371 (0.098)
Haemoglobin (g/dl) -0.001 (0.996) -0.052 (0.823)
TLC (/cumm) -0.153 (0.507) -0.019 (0.935)
Platelets (/cumm) -0.008 (0.973) 0.001 (0.998)
Blood urea (mg/dl) 0.057 (0.807) 0.463 (0.035*)
Serum creatinine (mg/ -0.107 (0.644) -0.092 (0.690)
dl)

Prothrombin Time 0.019 (0.935) -0.207 (0.369)

INR -0.016 (0.944) 0.036 (0.877)

Total Bilirubin (mg/dl) -0.069 (0.766) 0.068 (0.770)
Direct Bilirubin (mg/dl) -0.012 (0.957) 0.141 (0.543)
 Indirect Bilirubin (mg/dl) -0.103 (0.658) -0.003 (0.989)

SGOT (U/L) 0.247 (0.281) 0.213 (0.353)

SGPT (U/L) -0.338 (0.133) 0.036 (0.877)
ALP (U/L) -0.091 (0.695) -0.150 (0.516)
Serum Protein (g/dl) 0.060 (0.797) 0.039 (0.868)
Serum Albumin (g/dl) -0.217 (0.345) -0.053 (0.820)

*Significant

Spearman rank correlation analysis among Group B

Correlation between baseline characteristics and cortisol level in group II was evaluated. It was
observed that there was non-significant correlation between baseline characteristics and cortisol
level for all variables except for SGOT(p=0.007), SGPT(p=0.039) with delta cortisol levels, where a
statistically significant positive correlation was observed. The data is depicted in table 17.
Table 17: Spearman rank correlation analysis among Group B.

variable S. cortisol Delta

(after) r (p- cortisol r (p-
value) value)
Age (years) -0.037 (0.816) 0.016 (0.921)
Haemoglobin (g/dl) 0.154 (0.329) 0.079 (0.617)
TLC (/cumm) 0.161 (0.308) -0.002 (0.992)
Platelets (/cumm) 0.270 (0.083) 0.033 (0.835)
Blood urea (mg/dl) 0.021 (0.895) -0.082 (0.607)
Serum creatinine (mg/ 0.035 (0.826) 0.020 (0.9)
dl)

Prothrombin Time 0.003 (0.983) 0.169 (0.284)

INR -0.146 (0.357) 0.004 (0.979)

Total Bilirubin (mg/dl) 0.109 (0.491) 0.167 (0.290)
Direct Bilirubin (mg/dl) 0.072 (0.651) 0.129 (0.415)
 Indirect Bilirubin (mg/dl) 0.129 (0.415) 0.210 (0.181)

SGOT (U/L) 0.226 (0.150) 0.412 (0.007*)

SGPT (U/L) 0.191 (0.226) 0.320 (0.039*)

ALP (U/L) -0.151 (0.339) -0.064 (0.687)
Serum Protein (g/dl) -0.134 (0.398) -0.170 (0.282)
Serum Albumin (g/dl) 0.120 (0.449) -0.067 (0.672)

Spearman rank correlation analysis among Group C

Correlation between baseline characteristics and cortisol level in group III was evaluated. It was
observed that there was non-significant correlation between baseline characteristics and cortisol
level for all variables except for SGOT(p=0.016) and delta cortisol levels, where a statistically
significant positive correlation was observed.
Table 18: Spearman rank correlation analysis among Group C.

variable S. cortisol Delta

(after) r (p- cortisol r (p-
value) value)
Age (years) -0.033 (0.845) -0.020 (0.907)

Haemoglobin (g/dl) 0.186 (0.270) 0.237 (0.157)

TLC (/cumm) 0.317 (0.056) 0.224 (0.182)

Platelets (/cumm) -0.001 (0.996) -0.172 (0.308)

Blood urea (mg/dl) 0.164 (0.333) 0.188 (0.264)

Serum creatinine 0.013 (0.937) 0.071 (0.678)

(mg/dl)

Prothrombin Time -0.189 (0.262) -0.031 (0.857)

INR -0.253 (0.131) -0.151 (0.373)

Total Bilirubin (mg/dl) 0.091 (0.593) -0.010 (0.952)

Direct Bilirubin (mg/dl) 0.066 (0.698) -0.109 (0.520)

 Indirect Bilirubin (mg/dl) 0.091 (0.592) 0.005 (0.978)

SGOT (U/L) 0.147 (0.384) 0.395 (0.016*)

SGPT (U/L) -0.104 (0.541) 0.077 (0.649)

ALP (U/L) 0.234 (0.164) 0.312 (0.060)

Serum Protein (g/dl) -0.053 (0.757) 0.025 (0.882)

Serum Albumin (g/dl) -0.027 (0.874) 0.076 (0.653)

*Significant

Multivariate analysis between overall adrenal insufficiency and baseline parameters

Multivariate analysis of overall adrenal insufficiency and baseline parameters were evaluted. It was
observed that none of the variable was statistically significant

. Table 19 : Multivariate analysis between overall adrenal insufficiency and baseline parameters.

Variable Exp B (odds ratio) p-value

Haemoglobin (g/dl) 1.611 1
TLC (/cumm) 0.999 1
Platelets (/cumm) 0 0.999
Blood urea (mg/dl) 0.289 0.999
Serum creatinine (mg/dl) 1.340E + 14 0.999
Prothrombin Time 3.627 1
INR 1186.222 1
Total Bilirubin (mg/ dl) 3.567E+181 0.999
Direct Bilirubin (mg/ dl) 0 0.999
Indirect Bilirubin (mg/dl) 0 0.999
SGOT (U/L) 0.999 1
SGPT (U/L) 0.774 1
ALP (U/L) 1.024 1
Serum Protein (g/dl) 0.005 0.999
Serum Albumin (g/ dl) 10.684 1
Serum cortisol (baseline) 320.056 1
(mcg/dl)
Serum cortisol (post- test) 0 0.999
(mcg/dl)
Delta cortisol(mcg/ dl) 0.060 1
MELD score 0.145 0.999