ReviewIntensive care medicine2017
Critical illness-related corticosteroid insufficiency (CIRCI): a narrative review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM).
Review in Intensive care medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04280497 (A Multicentre Concealed-Allocation Multi-arms Blinded Randomized Controlled Trial to Identify the Best Sepsis Population for Corticotherapy), which is not on this map. Cited by 114 papers, 9 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Multicentre Concealed-Allocation Multi-arms Blinded Randomized Controlled Trial to Identify the Best Sepsis Population for Corticotherapy
Who cites it
114 citing papers in PubMed, 9 syntheses or guidelines pooled it, 206 citations in OpenAlex.
- Efficacy and safety of corticosteroids in critically ill patients: a systematic review and meta-analysis.BMC anesthesiology · 2025Pooled it
- Corticosteroids for treating sepsis in children and adults.The Cochrane database of systematic reviews · 2025Pooled it
- A systematic review and meta-analysis of glucocorticoids treatment in severe COVID-19: methylprednisolone versus dexamethasone.BMC infectious diseases · 2023Pooled it
- Relative adrenal insufficiency in the non-critically ill patient with cirrhosis: A systematic review and meta-analysis.Liver international : official journal of the International Association for the Study of the Liver · 2023Pooled it
- Update in Hyperferritinemic Syndromes: Recognition and Management - A Scoping Review.The Brown journal of hospital medicine · 2022Pooled it
- Corticosteroids for Treating Sepsis in Adult Patients: A Systematic Review and Meta-Analysis.Frontiers in immunology · 2021Pooled it
- Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature.Frontiers in medicine · 2020Pooled it
- Corticosteroids for treating sepsis in children and adults.The Cochrane database of systematic reviews · 2019Pooled it
- Corticosteroids as adjunctive therapy in the treatment of influenza.The Cochrane database of systematic reviews · 2019Pooled it
- Trial
- Timing of corticosteroids in non-severe non-hospitalized COVID-19 patients: open-label, two-center, randomized controlled study (TICS-COV19 study).The Korean journal of internal medicine · 2023Trial
- Corticotropin-stimulated steroid profiles to predict shock development and mortality in sepsis: From the HYPRESS study.Critical care (London, England) · 2022Trial
- [Hydrocortisone for septic shock: with or without fludrocortisone?]Die Anaesthesiologie · 2026Review
- Corticosteroids in immunocompromised ICU patients with pneumonia: risks, evidence, and clinical practice.Pneumonia (Nathan Qld.) · 2026Review
- Article
- Hypothalamic regulation of sepsis-associated anorexia: cytokine and hormonal signalling through AgRP/POMC circuits.EMBO molecular medicine · 2026Review
- Time-varying associations between corticosteroid dose and hospital mortality in ARDS: a sliding-window analysis of MIMIC-IV.BMC pulmonary medicine · 2026Observational
- Frequency of abnormal C-reactive protein concentrations in blood of dogs with hypoadrenocorticism.Journal of veterinary internal medicine · 2026Article
- Impact of glucocorticoid therapy on short- and long-term mortality in immunocompromised patients with community-acquired pneumonia in the ICU: a retrospective cohort study.BMC infectious diseases · 2026Article
- Sepsis as CNS-governed metabolic triage.Frontiers in immunology · 2026Review
54 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors at 15 institutions in 9 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo provide a narrative review of the latest concepts and understanding of the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI).
participantsA multispecialty task force of international experts in critical care medicine and endocrinology and members of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). DATA SOURCES: Medline, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews.
resultsThree major pathophysiologic events were considered to constitute CIRCI: dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, altered cortisol metabolism, and tissue resistance to glucocorticoids. The dysregulation of the HPA axis is complex, involving multidirectional crosstalk between the CRH/ACTH pathways, autonomic nervous system, vasopressinergic system, and immune system. Recent studies have demonstrated that plasma clearance of cortisol is markedly reduced during critical illness, explained by suppressed expression and activity of the primary cortisol-metabolizing enzymes in the liver and kidney. Despite the elevated cortisol levels during critical illness, tissue resistance to glucocorticoids is believed to occur due to insufficient glucocorticoid alpha-mediated anti-inflammatory activity.
conclusionsNovel insights into the pathophysiology of CIRCI add to the limitations of the current diagnostic tools to identify at-risk patients and may also impact how corticosteroids are used in patients with CIRCI.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.