Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
BMJ Open. 2024 Jan 29;14(1):e076582. doi: 10.1136/bmjopen-2023-076582.
Adrenal insufficiency (AI) is a rare disorder characterised by an impaired secretion of glucocorticoids from the adrenal glands. Treatment strategies for AI have developed over time with reduced glucocorticoid replacement doses and improved circadian exposure regimens, but whether this has resulted in better survival is unknown. The main purpose of this systematic review is to gather and synthesise available evidence on long-term mortality in patients with AI. The secondary aim is to study causes of death, with focus on cardiovascular and infectious diseases, in AI patients.
Studies published from the inception of respective databases (Medline, Embase, Cochrane and Web of Science) until the end of May 2023 will be systematically synthetised. Observational studies with a reference population will be included, and their quality will be assessed using the Newcastle-Ottawa scale. Data collected will be narratively integrated and a meta-analysis will be performed to pool data from studies considered homogeneous. The systematic review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This will be the first systematic review assessing mortality and causes of death in AI patients. The findings of this systematic review will be of value for both patients and healthcare providers.
This systematic review does not require ethical approval or informed consent because it will be based on previously published data only and does not implicate any direct contact with individual patients. The research results will be presented at scientific conferences and submitted for publication in an internationally recognised peer-reviewed scientific journal.
CRD42023416253.
肾上腺功能不全（AI）是一种罕见的疾病，其特征是肾上腺分泌的糖皮质激素减少。随着时间的推移，AI 的治疗策略已经发展，糖皮质激素替代剂量减少，昼夜节律暴露方案得到改善，但这是否导致生存状况改善尚不清楚。本系统评价的主要目的是收集和综合 AI 患者长期死亡率的现有证据。次要目的是研究 AI 患者的死亡原因，重点关注心血管疾病和传染病。
从各数据库（Medline、Embase、Cochrane 和 Web of Science）创建开始至 2023 年 5 月底，将系统地综合发表的研究。将纳入具有参考人群的观察性研究，并使用纽卡斯尔-渥太华量表评估其质量。收集的数据将进行叙述性综合，并进行荟萃分析以合并被认为同质的研究的数据。系统评价将按照系统评价和荟萃分析的首选报告项目进行报告。这将是第一个评估 AI 患者死亡率和死亡原因的系统评价。该系统评价的结果将对患者和医疗保健提供者都具有重要价值。
本系统评价不需要伦理批准或知情同意，因为它仅基于先前发表的数据，不涉及与个体患者的直接接触。研究结果将在科学会议上展示，并提交给国际认可的同行评审科学期刊发表。
PROSPERO 注册号：CRD42023416253。
