Is Preoperative Adrenal Insufficiency Screening Necessary for Cardiovascular Thoracic Surgery Patients?
Abstract
:1. Introduction
2. Materials and Methods
2.1. ACTH Stimulation Test
2.2. Definitions
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AI | Adrenal insufficiency |
ACTH | Adrenocorticotropic hormone |
CABG | Coronary artery bypass graft |
CIRCI | Critical illness-related corticosteroid insufficiency |
CI | Confidence interval |
HPA | Hypothalamic–pituitary–adrenal axis |
IV | Intravenous |
OR | Odds ratio |
RCT | Randomized controlled trial |
SD | Standard deviation |
References
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Characteristics | Adrenal Insufficiency (n = 34) | Normal Adrenal Response (n = 64) | p-Value |
---|---|---|---|
Baseline demographic data | |||
Age, mean ± SD (yr) | 57.67 ± 12.10 | 59.79 ± 10.59 | 0.37 |
Female, n (%) | 16 (47.06) | 30 (46.88) | 0.98 |
Body weight, mean ± SD (kgs) | 59.88 ± 9.96 | 60.24 ± 11.96 | 0.87 |
BMI, mean ± SD (kg/m2) | 23.37 ± 3.71 | 23.70 ± 4.03 | 0.69 |
Systolic blood pressure, mean ± SD (mmHg) | 119.85 ± 21.94 | 116.59 ± 24.04 | 0.51 |
Diastolic blood pressure, mean ± SD (mmHg) | 70.67 ± 11.62 | 70.89 ± 11.58 | 0.93 |
Underlying diseases, n (%)
| |||
17 (50.00) | 38 (60.32) | 0.32 | |
6 (17.65) | 20 (31.25) | 0.14 | |
18 (52.94) | 34 (53.13) | 0.98 | |
5 (14.71) | 8 (12.50) | 0.75 | |
0 (0) | 3 (4.69) | 0.20 | |
17 (50.00) | 29 (42.65) | 0.48 | |
Type of cardiothoracic surgery, n (%)
| |||
11 (32.35) | 34 (53.13) | ||
19 (55.88) | 26 (40.63) | ||
1 (2.94) | 0 (0) | ||
3 (8.82) | 4 (6.25) | 0.15 | |
Symptoms of adrenal insufficiency, n (%)
| |||
1 (2.94) | 2 (3.13) | ||
6 (17.65) | 10 (15.63) | ||
6 (17.65) | 3 (4.69) | ||
21 (61.76) | 49 (76.56) | 0.18 | |
History of exogenous glucocorticoid use, n (%) | 1 (2.94) | 5 (7.81) | 0.33 |
History of herbal/traditional medicine use, n (%) | 11 (32.35) | 15 (23.44) | 0.34 |
Baseline biochemical investigations | |||
8AM Serum cortisol, mean ± SD (µg/dL) | 8.30 ± 2.97 | 10.50 ± 3.26 | <0.005 |
ACTH stimulation test
| |||
6.88 ± 2.46 | 10.12 ± 3.29 | <0.005 | |
13.50 ± 1.94 | 18.71 ± 2.96 | <0.005 | |
14.97 ± 2.28 | 21.86 ± 2.97 | <0.005 | |
Serum albumin, mean ± SD (g/dL) | 4.07 ± 0.49 | 4.15 ± 0.47 | 0.38 |
Hemoglobin level, mean ± SD (g/dL) | 12.60 ± 2.10 | 12.25 ± 1.84 | 0.39 |
Total cholesterol, mean ± SD (mg/dL) | 149.91 ± 42.48 | 151.21 ± 40.06 | 0.88 |
LDL, mean ± SD (mg/dL) | 98.5 ± 37.31 | 100.38 ± 38.43 | 0.81 |
HDL, mean ± SD (mg/dL) | 44.52 ± 14.06 | 44.28 ± 15.36 | 0.93 |
Creatinine, mean ± SD (mg/dL) | 1.13 ± 0.61 | 1.19 ± 1.45 | 0.82 |
Serum sodium, mean ± SD (mmol/L) | 139.26 ± 2.89 | 137.07 ± 17.12 | 0.46 |
Serum potassium, mean ± SD (mmol/L) | 4.06 ± 0.48 | 4.41 ± 2.91 | 0.52 |
Serum bicarbonate, mean ± SD (mmol/L) | 27.08 ± 14.13 | 25.53 ± 9.26 | 0.51 |
Factors | Adrenal Insufficiency (n = 34) | Normal Adrenal Response (n = 64) | Adjusted ORs * | 95% Confidence Interval | p-Value |
---|---|---|---|---|---|
Prolonged length of hospital stay (>14 days) | 11 (32.32) | 16 (25.00) | 1.67 | 0.55–4.99 | 0.35 |
Postoperative infection | 7 (20.59) | 14 (21.88) | 1.16 | 0.38–3.56 | 0.79 |
Prolonged inotropic drug use (>48 h) | 2 (5.88) | 3 (4.69) | 1.45 | 0.20–10.32 | 0.71 |
CIRCI | 11 (32.35) | 19 (29.69) | 1.18 | 0.44–3.15 | 0.74 |
Required insulin infusion | 8 (23.53) | 9 (14.06) | 14.15 | 1.44–138.60 | 0.02 |
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Manosroi, W.; Atthakomol, P. Is Preoperative Adrenal Insufficiency Screening Necessary for Cardiovascular Thoracic Surgery Patients? Medicina 2023, 59, 152. https://doi.org/10.3390/medicina59010152
Manosroi W, Atthakomol P. Is Preoperative Adrenal Insufficiency Screening Necessary for Cardiovascular Thoracic Surgery Patients? Medicina. 2023; 59(1):152. https://doi.org/10.3390/medicina59010152
Chicago/Turabian StyleManosroi, Worapaka, and Pichitchai Atthakomol. 2023. "Is Preoperative Adrenal Insufficiency Screening Necessary for Cardiovascular Thoracic Surgery Patients?" Medicina 59, no. 1: 152. https://doi.org/10.3390/medicina59010152