الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Sepsis represents one of the most important reasons of progression of liver failure, development of liver-related complications, and mortality in patients with cirrhosis. Cirrhotic patients are susceptible to sepsis and critical illness-related corticosteroid insufficiency (CIRCI). Dehydroepiandrosterone sulfate is a corticotropin-dependent adrenal androgen, which has immunostimulating and antiglucocorticoid effects. Investigators have proposed measuring of cortisol and DHEAS as a ratio. The commonly used platelet indices include platelet count, mean platelet volume, platelet distribution width and plateletcrit. Originally, these indices have been applied in the diagnosis of hematological system diseases. A reduction in platelet count is an independent risk factor for critically ill patients in intensive care unit. Objectives: To investigate the relationship between DHEAS/cortisol ratio and platelet indices with illness severity and their performances in predicting prognosis in cirrhotic patients with sepsis. Methods: 3 cm of blood was withdrawn for complete blood picture, in order to know platelets count and platelet indices values, as well as 3 cm of blood was withdrawn and the serum was separated, then the value of DHEAS and cortisol was measured using ELISA kits then the ratio between them was calculated , this was done during the first 24 hours of patients’ admission and repeated after 72 hours. Results: Clinical and biochemical changes associated with sepsis with and without liver cirrhosis; • Platelets count revealed significant decrease in all septic groups in comparison to non-septic groups, MPV increased significantly in all sepsis groups, PDW was significantly higher in group sepsis without cirrhosis when compared to normal control group and PCT was significantly higher in all sepsis groups in comparison to control. Non survivors were significantly associated with higher levels of cortisol, but lower levels of DHEAS and DHEAS/Cortisol ratio. We built up a new equation to be used as a prognostic marker for good prognosis of patients with sepsis and it is as follows; Y=0.0091+0.063 x MPV (0: ≤10; 1: >10) + 0.2223 x DHEAS/cortisol ratio (0:>0.7; 1: ≤0.7)- 0.03 x APACHE II score (0:>9; 1: ≤9) Conclusion: This study shows that MPV, DHEAS/cortisol ratio in addition to APACHE II score can be used as simple, affordable and non-invasive measures for prognosis of cirrhotic patients with sepsis.