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Clinical significance of serum cortisol levels following surgery for congenital heart disease

Published online by Cambridge University Press:  29 April 2016

Alicia M. Teagarden  and
Christopher W. Mastropietro
Alicia M. Teagarden*
Affiliation:
Department of Pediatrics, Section of Critical Care, Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Indiana, United States of America
Christopher W. Mastropietro
Affiliation:
Department of Pediatrics, Section of Critical Care, Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Indiana, United States of America
*
Correspondence to: A. M. Teagarden, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Room 4925, Indianapolis, Indiana 46202. Tel: +317 944 7065; Fax: +317 944 3442; E-mail: [email protected]
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Abstract

Objective

Use of hydrocortisone to treat refractory haemodynamic instability in patients recovering from surgery for congenital heart disease is common practice at many centres. We aimed to determine whether there is a relationship between total serum cortisol concentrations and haemodynamic response to this therapy.

Material and methods

We retrospectively reviewed patients <21 years who underwent cardiac surgery from 2011 to 2013, received hydrocortisone within 72 hours postoperatively, and had total serum cortisol measurements contemporaneous with its administration. Favourable responders were defined as patients in whom, at 24 hours after hydrocortisone initiation, either (1) systolic blood pressure was increased or unchanged and vasoactive-inotrope score was decreased or (2) systolic blood pressure increased by ⩾10% of baseline and vasoactive-inotrope score was unchanged. Variables were compared using t-tests or Mann–Whitney U tests as appropriate.

Results

In total, 24 patients were reviewed, with a median age of 1.4 months and range of 0.1–232 months. Among them, 14 (58%) patients responded favourably to hydrocortisone. At 24 hours, the median change in vasoactive-inotrope score was −18% in favourable responders and +31% in those who did not respond favourably, p=0.001. The mean pre-hydrocortisone total serum cortisol in favourable responders was 17.4±10.9 µg/dl compared with 46.1±44.7 µg/dl in those who did not respond favourably, p=0.03.

Conclusion

Total serum cortisol obtained before initiation of hydrocortisone was significantly lower in patients who responded favourably to this therapy. Total serum cortisol may therefore be helpful in identifying children recovering from cardiac surgery who may or may not haemodynamically improve with hydrocortisone.

Keywords

Congenital heart diseasepaediatricpostoperative carehydrocortisonecortisol
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 2 , March 2017 , pp. 318 - 324
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Copyright
© Cambridge University Press 2016 

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References

1. Wernovsky, G, Wypij, D, Jonas, RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995; 92: 2226–2235.Google Scholar
2. Hoffman, TM, Wernovsky, G, Atz, AM, et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003; 107: 996–1002.Google Scholar
3. Shore, S, Nelson, DP, Pearl, JM, et al. Usefulness of corticosteroid therapy in decreasing epinephrine requirements in critically ill infants with congenital heart disease. Am J Cardiol 2001; 88: 591–594.Google Scholar
4. Ando, M, Park, IS, Wada, N, Takahashi, Y. Steroid supplementation: a legitimate pharmacotherapy after neonatal open heart surgery. Ann Thorac Surg 2005; 80: 1672–1678.CrossRefGoogle ScholarPubMed
5. Suominen, PK, Dickerson, HA, Moffett, BS, et al. Hemodynamic effects of rescue protocol hydrocortisone in neonates with low cardiac output syndrome after cardiac surgery. Pediatr Crit Care Med 2005; 6: 655–659.Google Scholar
6. Millar, KJ, Thiagarajan, RR, Laussen, PC. Glucocorticoid therapy for hypotension in the cardiac intensive care unit. Pediatr Cardiol 2007; 28: 176–182.CrossRefGoogle ScholarPubMed
7. Sasser, WC, Robert, SM, Carlo, WF, et al. Postoperative serum cortisol concentration and adrenal insufficiency in neonates undergoing open-heart surgery. World J Pediatr Congenit Heart Surg 2012; 3: 214–220.Google Scholar
8. Verweij, EJ, Hogenbirk, K, Roest, AA, van Brempt, R, Hazekamp, MG, de Jonge, E. Serum cortisol concentration with exploratory cut-off values do not predict the effects of hydrocortisone administration in children with low cardiac output after cardiac surgery. Interact Cardiovasc Thorac Surg 2012; 15: 685–689.Google Scholar
9. Jacobs, JP, O’Brien, SM, Pasquali, SK, et al. Variation in outcomes for risk-stratified pediatric cardiac surgical operations: an analysis of the STS Congenital Heart Surgery Database. Ann Thorac Surg 2012; 94: 564–571.CrossRefGoogle ScholarPubMed
10. Gaies, MG, Gurney, JG, Yen, AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.CrossRefGoogle ScholarPubMed
11. Pasquali, SK, Hall, M, Li, JS, et al. Corticosteroids and outcome in children undergoing congenital heart surgery: analysis of the Pediatric Health Information Systems database. Circulation 2010; 122: 2123–2130.Google Scholar
12. Mastropietro, CW, Davalos, MC, Seshadri, S, Walters, HL 3rd, Delius, RE. Clinical response to arginine vasopressin therapy after paediatric cardiac surgery. Cardiol Young. 2013; 23: 387–393.Google Scholar
13. Bronicki, RA. Is cardiac surgery sufficient to create insufficiency? Pediatr Crit Care Med 2010; 11: 150–151.CrossRefGoogle ScholarPubMed
14. Bronicki, RA, Chang, AC. Management of the postoperative pediatric cardiac surgical patient. Crit Care Med 2011; 39: 1974–1984.Google Scholar
15. Gajarski, RJ, Stefanelli, CB, Graziano, JN, Kaciroti, N, Charpie, JR, Vazquez, D. Adrenocortical response in infants undergoing cardiac surgery with cardiopulmonary bypass and circulatory arrest. Pediatr Crit Care Med 2010; 11: 44–51.Google Scholar
16. Wald, EL, Preze, E, Eickhoff, JC, Backer, CL. The effect of cardiopulmonary bypass on the hypothalamic-pituitary-adrenal axis in children. Pediatr Crit Care Med 2011; 12: 190–196.Google Scholar
17. Menon, K, Ward, RE, Lawson, ML, et al. A prospective multicenter study of adrenal function in critically ill children. Am J Respir Crit Care Med 2010; 182: 246–251.Google Scholar
18. Mastropietro, CW, Barrett, R, Davalos, MC, et al. Cumulative corticosteroid exposure and infection risk after complex pediatric cardiac surgery. Ann Thorac Surg 2013; 95: 2133–2139.CrossRefGoogle ScholarPubMed
19. Turcotte, RF, Brozovich, A, Corda, R, et al. Health care-associated infections in children after cardiac surgery. Pediatr Cardiol 2014; 35: 1448–1455.Google Scholar
20. Robert, SM, Borasino, S, Dabal, RJ, Cleveland, DC, Hock, KM, Alten, JA. Postoperative hydrocortisone infusion reduces the prevalence of low cardiac output syndrome after neonatal cardiopulmonary bypass. Pediatr Crit Care Med 2015; 16: 629–636.Google Scholar
21. Ito, S, Kusunoki, Y, Oka, T, Ito, Y, Okuno, A, Yoshioka, H. Pharmacokinetics of high-dose methylprednisolone in children. Dev Pharmacol Ther 1992; 19: 99–105.Google Scholar