Alcohol-associated hepatitis (AAH) is a disorder characterized by an abrupt onset of jaundice after excessive alcohol consumption. The precise incidence of AH is unknown, although a prevalence of alcohol-associated liver disease ranges from 10 to 35% in patients with active alcohol use disorder.1, 2 Alcohol-associated hepatitis has a broad clinical spectrum3, 4 with high mortality rates.5

Adrenal insufficiency (AI) is a common and recognized entity in patients with liver cirrhosis. Patients with liver cirrhosis have an impairment in cholesterol synthesis, increased levels of proinflammatory markers, and structural damage of the adrenal glands, which finally causes adrenal insufficiency.6, 7, 8 The relevance of AI in the setting of liver cirrhosis relies on its prevalence9, 10, 11 and its dismal outcome.12, 13, 14, 15 Nevertheless, scarce data on AI in patients with AAH exist in the field.16 Relative adrenal insufficiency (RAI), a condition characterized by failure of the adrenal gland to produce steroid hormones sufficient to meet the peripheral requirements, has also been associated with early mortality in acute-on-chronic liver failure and severe AAH.16, 17 In addition, a recent study found an association between low delta cortisol levels and severe AAH. Still, the association between overall survival and delta cortisol levels has yet to be studied. This study aimed to document the prevalence and prognostic implication of RAI in patients with severe AAH.