Increased mortality in primary adrenal insufficiency: a systematic review and meta-analysis
Bibliographic record
Abstract
OBJECTIVE: Despite important advances in the management of primary adrenal insufficiency (PAI), prognosis in these patients remains poor. Data on mortality in PAI has not been entirely consistent, and to date, no systematic synthesis has been performed. The aim of this study was to conduct a systematic review and a meta-analysis to synthesize available evidence on mortality in adult patients with PAI including congenital adrenal hyperplasia (CAH). DESIGN: This is a systematic review and meta-analysis. METHODS: Medline, Cochrane CENTRAL, Web of Science, and Embase databases were searched for studies on mortality in PAI. The results were screened by 2 reviewers by titles and abstracts, and selected articles were subsequently reviewed in full text. Observational studies on mortality compared to a reference population were included. RESULTS: Out of the 6238 reports identified, 9 reports were included in the systematic review, with a total population of 13 969 patients. Two of the 9 studies included overlapping population; therefore, only 7 studies were included in the meta-analysis (9876 patients). Four studies assessed mortality utilizing hazard ratio (HR) with a pooled HR of 2.51 (95% confidence interval [CI] 1.47-4.31, I2 = 86.1%); 3 studies used standardized mortality ratio (SMR) with a pooled SMR of 2.49 (95% CI 0.99-6.28, I2 = 97.9%). The main cause of death was cardiovascular disease. A sub-analysis of patients with CAH showed a pooled HR of 2.88 (95% CI 1.38-6.01, I2 = 90.3%), with the main cause of death being adrenal crisis. CONCLUSIONS: Mortality in patients with PAI was increased 2.5-fold compared to the reference population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.034 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.018 | 0.041 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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 source (direct Gemma or distilled Codex), 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".