A characterization of cortisol level and adrenal reservation in human cardiopulmonary arrest: systematic review and meta-analysis

Abstract

Background Cardiopulmonary arrest (CPA) is an urgency, which is associated with high mortality. This systematic review evaluated the relationship between baseline cortisol level and the outcome of resuscitated CPA patients. Methods We searched the following databases: PubMed, Scopus, ISI Web of Science, and Google Scholar. Relevant observational and controlled trials were explored from inception by April 2020. The quality of the articles was assessed using the Newcastle-Ottawa Scale (NOS). Results Finally, five cohort studies (n = 201 participants in total) were eligible for including in the meta-analysis. The results of this meta-analysis showed that although the baseline serum cortisol levels were higher in survivors of cardiac arrest compared with non-survivors, the differences between groups do not reach a significance level (Hedges’ g = 0.371, 95% CI, −0.727, 1.469, P value = 0.508). Between-study heterogeneity was statistically significant (Cochrane Q test: P value < 0.001, I2 = 89.323). Conclusions The result of the present meta-analysis was suggestive of a higher baseline serum cortisol levels in survivors of CPA. Future randomized controlled studies with a large sample size will determine the exact relationship between adrenal reservation and the eventual outcome of patients with CPA. Systematic review registration PROSPERO CRD42018085468

Effect of corticosteroid administration on cardiac arrest: a systematic review and network meta-analysis of the timing of administration

“…Considering that patients administered corticosteroids prior to CA, when included in our network meta-analysis, included those in whom a history of corticosteroid administration was identified during a short-term period before the CA event, it is likely that this group included chronic corticosteroid users. Adrenal insufficiency associated with chronic corticosteroid use may explain the worse prognosis in this group [ 44 ]. However, this result would better be accepted as a phenomenon showing that the prognosis is worse than that of the control group in a situation where relative adrenal insufficiency is suspected rather than as a recommendation for the timing of administration, considering that the “prior to CA” classification in original studies was not based on an actual timing of intervention but instead was a result of retrospective observation.…”

“…Adrenal insufficiency associated with chronic corticosteroid use may explain the worse prognosis in this group. 41 However, this result would better be accepted as a phenomenon showing that the prognosis is worse than that of the control group in a situation where relative adrenal insufficiency is suspected rather than as a recommendation for the timing of administration, considering that the "prior to CA" classification in original studies was not based on an actual timing of intervention but instead was a result of retrospective observation.…”