Relative adrenal insufficiency in patients with severe acute pancreatitis
Bibliographic record
Abstract
Inadequate cortisol levels and adrenal dysfunction may play a role in the pathophysiology of severe acute pancreatitis. This study aimed to analyse the incidence of relative adrenal insufficiency (RAI) in these patients, to identify factors associated with relative adrenal insufficiency and to describe how adrenal responsiveness affects outcome. In a prospective observational multicenter study, a short Synacthen test (SST) was performed within 5 days after admission to the hospital in 25 patients with severe acute pancreatitis, after signed informed consent was obtained. The incidence of RAI, defined as an increment after SST of less than 9 μg/dl, was the primary endpoint of the study. Serum cortisol was measured at baseline and 30 and 60 minutes after 250 μg adrenocorticotropic hormone administration. The median baseline cortisol level was 26.6 μg/dl, and increased to 43.2 μg/dl and 48.8 μg/dl after 30 and 60 minutes, respectively. RAI was found in 16% of all patients, and in 27% of patients with organ dysfunction. Patients with RAI were more severely ill and had higher SOFA scores from day 4 through day 7 after admission. All patients with RAI developed pancreatic necrosis, and all of them needed surgical intervention. Mortality was significantly higher in patients with RAI (75% vs 10%, P = 0.016). Patients who died had a lower increment in cortisol levels after the SST than patients who survived. RAI is frequent in patients with severe acute pancreatitis and organ dysfunction. It occurs in patients with more severe pancreatitis and is associated with an increased mortality rate.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".