Evidence map›Paper›PMID 36354293›Full record

SynthesisLiver international : official journal of the International Association for the Study of the Liver2023

Relative adrenal insufficiency in the non-critically ill patient with cirrhosis: A systematic review and meta-analysis.

Brian J Wentworth, Matthew Schliep, Wendy Novicoff, Helmy M Siragy, Calvin X Geng, Zachary H Henry

Registry-linked trialOpen access · greenAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Liver international : official journal of the International Association for the Study of the Liver, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06206655 (Investigation of Incidence and Proper Diagnostic Method for Adrenal Insufficiency in Liver Cirrhosis Patients), which is not on this map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
1.7field-weighted citation impact, top 14% of its field
1 · What the graph read from 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.

2 · The registry

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.

NCT06206655 unknown statusnot on this map

Investigation of Incidence and Proper Diagnostic Method for Adrenal Insufficiency in Liver Cirrhosis Patients

TypeobservationalSponsorSeoul National University HospitalRan2023 to 2024Enrolled50ConditionsAdrenal Insufficiency, Liver CirrhosisArmsrapid ACTH stimulation test
3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 12 citations in OpenAlex.

  1. Article
  2. Article
  3. Review
  4. Review
  5. Article
  6. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Brian J WentworthDivision of Gastroenterology & Hepatology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA.ORCID 0000-0003-3642-887X
Matthew SchliepDepartment of Medicine, School of Medicine, University of Virginia, Charlottesville, Virginia, USA.ORCID 0000-0001-9742-6777
Wendy NovicoffDepartments of Public Health Sciences and Orthopaedic Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia, USA.ORCID 0000-0002-5146-7706
Helmy M SiragyDivision of Endocrinology & Metabolism, School of Medicine, Charlottesville, Virginia, USA.ORCID 0000-0001-8121-9052
Calvin X GengDepartment of Medicine, School of Medicine, University of Virginia, Charlottesville, Virginia, USA.ORCID 0000-0001-7583-9191
Zachary H HenryDivision of Gastroenterology & Hepatology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA.ORCID 0000-0003-1168-7621
University of Virginia · USCharlottesville Medical Research · US

Funding

Prorenin Receptors Mediate Hypertension and Kidney Disease in DiabetesR01HL091535 · NHLBI · UNIVERSITY OF VIRGINIA · PI SIRAGY, HELMY M · 2008 to 2020
$5.1M
(Pro)renin receptor mediates obesity induced hypertensionR01DK114875 · NIDDK · UNIVERSITY OF VIRGINIA · PI SIRAGY, HELMY M · 2017 to 2020
$1.5M
NHLBI NIH HHS R01 HL091535NIDDK NIH HHS R01 DK114875
6 · The paper itself

Abstract

BACKGROUND &

aimsCharacterization of relative adrenal insufficiency (RAI) in cirrhosis is heterogeneous with regard to studied patient populations and diagnostic methodology. We aimed to describe the prevalence and prognostic importance of RAI in non-critically ill patients with cirrhosis.

methodsA systematic review and meta-analysis was performed using MeSH terms and Boolean operators to search five large databases (Ovid-MEDLINE, ScienceDirect, Web of Science, Cochrane Library and ClinicalTrials.gov). The population of interest was patients with cirrhosis and without critical illness. The primary outcome was the pooled prevalence of RAI as defined by a peak total cortisol level <18 μg/dl, delta total cortisol <9 μg/dl or composite of the two thresholds in response either a standard-dose or low-dose short synacthen test. Odds ratios and standardized mean differences from random-effects models estimated important clinical outcomes and patient characteristics by adrenal functional status.

resultsTwenty-two studies were included in final analysis, comprising 1991 patients with cirrhosis. The pooled prevalence of RAI was 37% (95% CI 33-42%). The prevalence of RAI varied by Child-Pugh classification, type of stimulation test used, specific diagnostic threshold and by severity of illness. Ninety-day mortality was significantly higher in patients with RAI (OR 2.88, 95% CI 1.69-4.92, I2 = 15%, p < 0.001).

conclusionsRelative adrenal insufficiency is highly prevalent in non-critically ill patients with cirrhosis and associated with increased mortality. Despite the proposed multifactorial pathogenesis, no studies to date have investigated therapeutic interventions in this specific population.

Indexed as

Adrenal InsufficiencyHydrocortisoneCritical IllnessHumansLiver CirrhosisPrognosisHydrocortisoneadrenal insufficiencycirrhosislivermeta-analysisoutcomes research

Identifiers

PMID36354293
PMCPMC9974795
OpenAlexW4308684046

What OpenQuestion holds

Textmetadata
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Read underepoch 390

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.