Strengths and limitations
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MALNOURISHED, INFLAMMATION, SECONDARY
Following an intensive search, we believe this secondary analysis of a randomized controlled clinical trial to be the first to investigate the predictive value of cortisol levels in a population of malnourished medical inpatients. We also performed analyses which stratified for CRP levels to investigate the effect of inflammation. There are, however, several limitations to this study. First of all, the sample size may have been too small to produce significant interactions in some of the outcomes. There is also a possible selection bias due to some missing cortisol test results. Although the circadian rhythm of cortisol was not investigated, most measurements were taken in the morning and from acutely ill patients - where circadian rhythms are disturbed regardless. We did not record the actual time of blood draw and were thus not able to adjust the analysis accordingly. Due to the undefined cut-off for high cortisol, we choose quartiles which could be difficult to compare with future studies. Finally, as this is a secondary analysis, our results are hypothesis-generating rather than definitive; and require validation in an independent sample.