Gaeun Kim1, Ji Hye Huh2, Kyong Joo Lee2, Moon Young Kim2,3, Kwang Yong Shim2, Soon Koo Baik4,5,6. 1. Research Institute for Nursing Science, College of Nursing, Keimyung University, Daegu, Republic of Korea. 2. Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426, Republic of Korea. 3. Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. 4. Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426, Republic of Korea. baiksk@yonsei.ac.kr. 5. Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. baiksk@yonsei.ac.kr. 6. Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. baiksk@yonsei.ac.kr.
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.
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 cirrhoticpatients in terms of hospital survival rate. CONCLUSIONS: Based on this SR and MA, critically illpatients with cirrhosis have a high risk of RAI, and the presence of RAI is related to a poor prognosis and occurrence of cirrhotic complications.
Authors: Ki Tae Suk; Jung-Hwan Yoon; Moon Young Kim; Chang Wook Kim; Ja Kyung Kim; Hana Park; Seong Gyu Hwang; Dong Joon Kim; Byung Seok Lee; Sae Hwan Lee; Hong Soo Kim; Jae Young Jang; Chang-Hyeong Lee; Byung Seok Kim; Yoon Ok Jang; Mee Yon Cho; Eun Sun Jung; Yong Man Kim; Si Hyun Bae; Soon Koo Baik Journal: Hepatology Date: 2016-07-30 Impact factor: 17.425
Authors: J Y Jang; T Y Kim; J H Sohn; T H Lee; S W Jeong; E J Park; S H Lee; S G Kim; Y S Kim; H S Kim; B S Kim Journal: Aliment Pharmacol Ther Date: 2014-07-30 Impact factor: 8.171
Authors: Stefan R Bornstein; Bruno Allolio; Wiebke Arlt; Andreas Barthel; Andrew Don-Wauchope; Gary D Hammer; Eystein S Husebye; Deborah P Merke; M Hassan Murad; Constantine A Stratakis; David J Torpy Journal: J Clin Endocrinol Metab Date: 2016-01-13 Impact factor: 5.958
Authors: Ki Tae Suk; Moon Young Kim; Soung Won Jeong; Jae Young Jang; Yoon Ok Jang; Soon Koo Baik Journal: Dig Dis Sci Date: 2017-12-01 Impact factor: 3.199