Low testosterone levels as an independent predictor of mortality in men with chronic liver disease.

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 nm), and 90% of men had a low calculated free testosterone level (cFT, <230 pm). 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 nm and in cFT by 10 pm 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.