Anaesthesia and Critical Care Medicine, Department of Medical, Surgical and Experimental Science, University Hospital, University of Sassari, Sassari, Italy.
Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy.
J Endocrinol Invest. 2021 Jul;44(7):1533-1541. doi: 10.1007/s40618-020-01465-5. Epub 2020 Nov 27.
Vasoplegia often complicates on-pump cardiac surgery. Systemic inflammatory response induced by extracorporeal circulation represents the major determinant, but adrenal insufficiency and postoperative vasopressin deficiency may have a role. Pathophysiological meaning of perioperative changes in endocrine markers of hydro-electrolyte balance has not still fully elucidated. Objectives of the present research study were to estimate the incidence of vasoplegia in a homogeneous cohort of not severe cardiopathic patients, to define the role of presurgical adrenal insufficiency, to evaluate copeptin and NT-proBNP trends in the perioperative.
We conducted a prospective cohort study in the cardiac intensive care unit of a tertiary referral center. We evaluated 350 consecutive patients scheduled for cardiac surgery; 55 subjects completed the study. Both standard and low-dose corticotropin stimulation tests were performed in the preoperative; copeptin and NT-proBNP were evaluated in the preoperative (T0), on day 1 (T1) and day 7 (T2) after surgery.
Nine subjects (16.3%) developed vasoplegic syndrome with longer bypass and clamping time (p < 0.001). Reduced response to low-dose ACTH test was not associated to vasoplegia. Preoperative copeptin > 16.9 pmol/L accurately predicted the syndrome (AUC 0.86, 95% CI 0.73-0.94; OR 1.17, 95% CI 1.04-1.32). An evident correlation was observed at 7 days postoperative between NT-proBNP and copeptin (r 0.88, 95% CI 0.8-0.93; p < 0.001).
Preoperative impaired response to low-dose ACTH stimulation test is not a risk factor for post-cardiotomic vasoplegia; conversely, higher preoperative copeptin predicts the complication. On-pump cardiac surgery could be an interesting model of rapid heart failure progression.
体外循环引起的全身炎症反应是心脏手术后并发血管麻痹的主要决定因素，但肾上腺功能不全和术后血管加压素缺乏也可能起作用。围手术期水-电解质平衡内分泌标志物变化的病理生理意义尚未完全阐明。本研究的目的是评估非严重心脏病患者同质队列中血管麻痹的发生率，确定术前肾上腺功能不全的作用，并评估围手术期 copeptin 和 NT-proBNP 的趋势。
我们在一家三级转诊中心的心脏重症监护病房进行了一项前瞻性队列研究。我们评估了 350 例计划接受心脏手术的连续患者；55 例患者完成了这项研究。所有患者均在术前进行标准和低剂量促皮质素刺激试验；在术前（T0）、术后第 1 天（T1）和第 7 天（T2）评估 copeptin 和 NT-proBNP。
9 例（16.3%）患者发生血管麻痹综合征，体外循环和夹闭时间较长（p<0.001）。低剂量 ACTH 试验反应降低与血管麻痹无关。术前 copeptin>16.9 pmol/L 可准确预测该综合征（AUC 0.86，95%CI 0.73-0.94；OR 1.17，95%CI 1.04-1.32）。术后第 7 天，NT-proBNP 和 copeptin 之间存在明显相关性（r=0.88，95%CI 0.8-0.93；p<0.001）。
术前低剂量 ACTH 刺激试验反应受损不是心脏手术后血管麻痹的危险因素；相反，术前 copeptin 升高可预测该并发症。体外循环心脏手术可能是快速心力衰竭进展的一个有趣模型。
