Digestive Diseases and Sciences

, Volume 62, Issue 4, pp 1067–1079 | Cite as

Relative Adrenal Insufficiency in Patients with Cirrhosis: A Systematic Review and Meta-Analysis

  • Gaeun Kim
  • Ji Hye Huh
  • Kyong Joo Lee
  • Moon Young Kim
  • Kwang Yong Shim
  • Soon Koo Baik
Original Article

Abstract

Background

Relative adrenal insufficiency (RAI) is frequently observed in patients with cirrhosis. We sought to identify evidence in the literature regarding the impact of RAI on clinical outcomes in cirrhotic patients.

Methods

We conducted a systematic review (SR) and meta-analysis (MA) using the Ovid-MEDLINE, EMBASE, and Cochrane Library databases to identify relevant studies in the literature.

Results

Of the 182 studies identified, 16 were eligible according to our inclusion criteria. The prevalence of RAI was 49.4% (744/1507), and cirrhotic patients with acute critical illnesses such as sepsis were more likely to have RAI compared to those without critical illnesses (P < 0.001). With respect to clinical outcomes, patients with RAI had poorer survival rates and an increased risk of complications such as bleeding and hepatorenal syndrome compared to those without RAI. Corticosteroid therapy had a beneficial effect on critically ill cirrhotic patients in terms of hospital survival rate.

Conclusions

Based on this SR and MA, critically ill patients with cirrhosis have a high risk of RAI, and the presence of RAI is related to a poor prognosis and occurrence of cirrhotic complications.

Keywords

Adrenal insufficiency Cirrhosis Systematic review Meta-analysis 

Abbreviations

RAI

Relative adrenal insufficiency

LT

Liver transplantation

SR

Systematic review

MA

Meta-analysis

PRISMA

Preferred reporting items for systematic reviews and meta-analyses

SD-SST

Standard-dose short synacthen test

Non-RCT

Non-randomized controlled trial

HRS

Hepatic renal syndrome

MAP

Mean arterial pressure

SOFA

Sequential Organ Failure Assessment

APACHE III

Acute Physiology and Chronic Health Evaluation III

IIHT

Insulin-induced hypoglycemia test

CRHT

Corticotropin-releasing hormone test

ACTH

Adrenocorticotropic hormone

Notes

Acknowledgments

This research was supported by the Bisa Research Grant (2016-0148) of Keimyung University.

Author’s Contribution

G.E.K. and S.K.B. designed the analysis. G.E.K. and S.K.B. formulated the model. G.E.K., H.J.H., K.J.L., M.Y.K., and K.Y.S. analyzed the data. G.E.K., H.J.H., and S.K.B. wrote the manuscript. All authors approved and reviewed the manuscript.

Compliance with ethical standards

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Gaeun Kim
    • 1
  • Ji Hye Huh
    • 2
  • Kyong Joo Lee
    • 2
  • Moon Young Kim
    • 2
    • 3
  • Kwang Yong Shim
    • 2
  • Soon Koo Baik
    • 2
    • 3
    • 4
  1. 1.Research Institute for Nursing Science, College of NursingKeimyung UniversityDaeguRepublic of Korea
  2. 2.Department of Internal MedicineYonsei University Wonju College of MedicineWonjuRepublic of Korea
  3. 3.Cell Therapy and Tissue Engineering CenterYonsei University Wonju College of MedicineWonjuRepublic of Korea
  4. 4.Institute of Evidence Based MedicineYonsei University Wonju College of MedicineWonjuRepublic of Korea

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