A Prospective Cohort Evaluation of the Cortisol Response to Cardiac Surgery with Occurrence of Early Postoperative Cognitive Decline

Glumac, Sandro; Kardum, Goran; Karanović, Nenad

doi:10.12659/msm.908251

Cited by 15 publications

(14 citation statements)

References 31 publications

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“…Glumac et al. 26 revealed that the stress response to surgical procedures is unlikely to represent an exclusive trigger for the occurrence of POCD and that interdependent mechanisms, such as inflammatory and stress responses, may be involved in the pathogenesis of POCD through their interaction effects. In the present study, we evaluated different operations performed by different surgeons.…”

Section: Discussionmentioning

confidence: 99%

Preoperative smoking history is associated with decreased risk of early postoperative cognitive dysfunction in patients of advanced age after noncardiac surgery: a prospective observational cohort study

Wang

Liu³

et al. 2018

J Int Med Res

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Objective Prevention of postoperative cognitive dysfunction (POCD) in patients of advanced age remains unclear. Studies have shown that the cholinergic anti-inflammatory pathway contributes to a decreased risk of POCD and that nicotine stimulates the cholinergic anti-inflammatory pathway. We investigated whether patients of advanced age with a preoperative smoking history have a decreased risk of POCD. Methods In total, 382 patients (190 smokers, 192 nonsmokers) aged ≥60 years who underwent major noncardiac surgery were enrolled. Cognitive function was assessed, and multivariate logistic regression analyses were performed to identify risk factors. Results On postoperative days 5 and 7, 111 (29.05%) and 90 (23.56%) patients exhibited POCD, respectively. A preoperative smoking history was significantly correlated with a decreased risk of POCD. A high serum tumor necrosis factor-α (TNF-α) level on the operative day was significantly associated with an increased risk of POCD. Early POCD was significantly associated with the sufentanil dosage, age, and education level. The hospital stay in patients with and without POCD was 10.54 ± 2.03 and 8.33 ± 1.58 days, respectively. Conclusion A preoperative smoking history was associated with a decreased risk of early POCD, and a high serum TNF-α level was significantly associated with an increased risk of POCD.

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Section: Discussionmentioning

confidence: 99%

Preoperative smoking history is associated with decreased risk of early postoperative cognitive dysfunction in patients of advanced age after noncardiac surgery: a prospective observational cohort study

Wang

Liu³

et al. 2018

J Int Med Res

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“…The opposite results reached S. Glumac et al [18] in a prospective cohort study of patients who underwent planned heart surgery. Cortisol levels were determined the day before surgery, 1 day after surgery (08-00, 16-00 and 24-00), for 3 and 5 days.…”

Section: Discussion Of Research Resultsmentioning

confidence: 85%

Stress response and state of cognitive functions in the perioperative period in elderly patients during laparoscopic cholecystectomy

Bielykh

Georgiyants

Vysotska

et al. 2021

SR:MS

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The aim. To investigate the dynamics of stress markers and the state of cognitive functions in the perioperative period during laparoscopic cholecystectomy in elderly patients. Materials and methods. We examined 84 patients aged 68.1 ± 0.6 years, with diagnosed gallstone disease, acute cholecystitis, who underwent laparoscopic cholecystectomy. Patients were randomized into 2 groups: Group I - inhalation anesthesia based on sevoflurane with mechanical ventilation; Group II - TBA based on propofol with mechanical ventilation. Hemodynamic parameters, dynamics of stress markers (cortisol, insulin, glucose) and cognitive function were investigated. Results. Glucose and insulin levels in both groups remained within normal limits at all stages of the study. The baseline cortisol level was higher than normal in both groups, but at 4, 5, 6 stages of the study decreased significantly compared with baseline values (p<0.001). In the study of cognitive functions by the Luria test and the MMSE scale, a significant decrease was found in both groups on the day after surgery. According to the Luria test, the score in group I significantly decreased the day after surgery against the period before premedication by 8.7% (p<0.001), in group II - by 10.1% (p<0.001); according to the MMSE scale, the score in group I significantly decreased on the day after surgery against the period before premedication by 6.0% (p<0.001), in group II - by 6.3% (p<0.001). On the fifth postoperative day, no significant differences in baseline values between the Luria test and the MMSE scale were detected. Conclusions. The comparative analysis of the dynamics of stress marker levels in both groups revealed some advantages of general sevoflurane-based anesthesia in antistress protection of patients in the perioperative period during laparoscopic cholecystectomy compared with total intravenous anesthesia based on propofol. However, the effectiveness of anti-stress protection of both types of anesthesia was sufficient. According to the correlation analysis, an inverse correlation was found between the state of cognitive functions in the postoperative period and the level of cortisol in the intraoperative period

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“…The studies showed that high serum cortisol levels can predict adverse outcome in patients with severe community acquired pneumonia, cardiac event risk in chronic heart failure, survival state in resuscitated cardiopulmonary arrest, mortality risk in chronic haemodialysis, and development of postoperative cognitive dysfunction following cardiac surgery. (9)(10)(11)(12)(13)(14)(15) To our knowledge, this is the first study to investigate the association between cortisol levels and surgical abdominal pain. It's an important problem to estimate surgical disease in patients with abdominal pain, especially at the early stage of 21) NLR is a predictor of acute inflammation and was recently studied in many clinical conditions for the diagnosis or prognosis.…”

Section: Discussionmentioning

confidence: 96%

Serum cortisol level as a useful predictor of surgical disease in patients with acute abdominal pain

2019

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Introduction. The immediate aim should be to identify potentially resuscitative acute abdominal pain that requires prompt investigation or early surgical intervention. We aimed to evaluate whether serum cortisol levels differentiate surgical and non-surgical disease in patients with acute abdominal pain. Materials and methods. In this prospective cross-sectional study, the primary end-point was defined as differences in serum cortisol levels between surgically and non-surgically treated patients with non-traumatic acute abdominal pain. The secondary end-point was to compare the cortisol levels with defined complete blood count (CBC) parameters in those groups. Results. One hundred eleven patients with acute abdominal pain were included in the study. Three most frequent diagnoses were nonspecific abdominal pain, acute appendicitis and dyspeptic complaints. Thirty patients were hospitalized and 22 of them were operated. The median cortisol level was 23.13 µg/dl in surgically treated patients and 13.94 µg/dl in non-surgically treated patients (p<0.001). The area under the ROC curve using cortisol to detect surgical disease was 0.750 (95% CI, 0.659-0.827) and the accuracy of cortisol to detect surgical disease was not inferior to defined CBC parameters. A cortisol value of 17.98 µg/dl had a sensitivity of 67.4% and a specificity of 77.3% for surgical disease. Conclusion. Operated patients had higher serum cortisol levels. High serum cortisol levels may indicate surgical disease at the early stage on admission in ED patients with acute abdominal pain and may be used as a marker in the prediction of acute surgical abdomen.

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A Prospective Cohort Evaluation of the Cortisol Response to Cardiac Surgery with Occurrence of Early Postoperative Cognitive Decline

Cited by 15 publications

References 31 publications

Preoperative smoking history is associated with decreased risk of early postoperative cognitive dysfunction in patients of advanced age after noncardiac surgery: a prospective observational cohort study

Preoperative smoking history is associated with decreased risk of early postoperative cognitive dysfunction in patients of advanced age after noncardiac surgery: a prospective observational cohort study

Stress response and state of cognitive functions in the perioperative period in elderly patients during laparoscopic cholecystectomy

Serum cortisol level as a useful predictor of surgical disease in patients with acute abdominal pain

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