Cardiac surgery: postop adrenal insufficiency predicts hemodynamic instability

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Takeaway

  • 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.

Key results

  • 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).

Study design

  • 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.

Limitations

  • Single-center study.
  • Relatively small sample size.
  • Observational study.