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Neuroendocrine predictors of vasoplegia after cardiopulmonary bypass.

Anaesthesia and Critical Care Medicine, Department of Medical, Surgical and Experimental Science, University Hospital, University of Sassari, Sassari, Italy. danielacristina.pasero@gmail.com. Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy. Department of Surgical Science, University of Turin, Turin, Italy. Department of Anesthesiology, Critical Care and Emergency Medicine, Cardiac Intensive Care Unit, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy. Clinical Biochemistry Laboratory, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy.

Journal of endocrinological investigation. 2021;(7):1533-1541
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Abstract

PURPOSE 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. METHODS 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. RESULTS 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). CONCLUSION 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.