- A prospective study finds that relative adrenal insufficiency after cardiac surgery is associated with increased risk for persistent hemodynamic instability.
Why this matters
- Study suggests that relative adrenal insufficiency is common after cardiac surgery and might explain a persistent need for vasopressors.
- 56% of patients were diagnosed with postoperative relative adrenal insufficiency (peak cortisol level <500 nmol/L and/or increase in cortisol <250 nmol/L compared with baseline) at 36 hours.
- Relative adrenal insufficiency was associated with higher rates of hemodynamic instability at 48 hours (40% vs 22%; P=.026).
- Lower adrenal function was associated with hemodynamic instability at 48 hours in multivariate analysis (OR, 1.06 [95% CI, 1.02-1.11] per 10 nmol/L cortisol decrease; P=.002).
- 135 patients who underwent cardiopulmonary bypass were analyzed for adrenal function by cosyntropin stimulation test and associations with hemodynamic instability (persistent requirement for vasoactive drug) and survival.
- Funding: None disclosed.
- Single-center study.
- Relatively small sample size.
- Observational study.