Relative Adrenal Insufficiency in Patients with Cirrhosis: A Systematic Review and Meta-Analysis
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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.
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.
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.
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.
KeywordsAdrenal insufficiency Cirrhosis Systematic review Meta-analysis
Relative adrenal insufficiency
Preferred reporting items for systematic reviews and meta-analyses
Standard-dose short synacthen test
Non-randomized controlled trial
Hepatic renal syndrome
Mean arterial pressure
Sequential Organ Failure Assessment
- APACHE III
Acute Physiology and Chronic Health Evaluation III
Insulin-induced hypoglycemia test
Corticotropin-releasing hormone test
This research was supported by the Bisa Research Grant (2016-0148) of Keimyung University.
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
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