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Low testosterone levels as an independent predictor of mortality in men with chronic liver disease
Author(s) -
Grossmann Mathis,
Hoermann Rudolf,
Gani Linsey,
Chan Irene,
Cheung Ada,
Gow Paul J,
Li Angela,
Zajac Jeffrey D.,
Angus Peter
Publication year - 2012
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2012.04347.x
Subject(s) - medicine , endocrinology , testosterone (patch) , chronic liver disease , liver disease , disease , biology , cirrhosis
Objective To examine the prevalence and prognostic implications of low serum testosterone levels in men with chronic liver disease. Design We conducted an observational study at a tertiary referral centre. Patients and measurements Baseline serum testosterone was measured in 171 men presenting to the Victorian Liver Transplant Unit for liver transplant evaluation. Patients were followed up to liver transplant or death. Results Sixty‐one per cent of men had a low total testosterone level (TT, <10 n m ), and 90% of men had a low calculated free testosterone level ( cFT , <230 p m ). During the available observation time (median 8 months, interquartile range 4–14 months), 56 men (33%) died and 63 (37%) received a liver transplant. Fifty‐two (30%) survived without a transplant. Median time to death was 8 months (range 2–13) and to liver transplant was 8 months (4–14). Baseline low TT and cFT levels both ( P < 0·0001) predicted mortality. Moreover, in a Cox proportional hazard model, both low total ( P = 0·02) and free testosterone ( P = 0·007) levels remained predictive of death independently of established prognostic factors, such as the model for end‐stage liver disease (MELD) score and serum sodium levels. A decrease in TT by 1 n m and in cFT by 10 p m was associated with an 8% increase in mortality. Conclusions Low testosterone levels are common in men with severe liver disease and predict mortality independent of MELD , the standard score used to prioritize the allocation of liver transplants.