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Szécsi B, Tóth K, Szabó A, Eke C, Szentgróti R, Dohán O, Benke K, Radovits T, Pólos M, Merkely B, Gál J, Székely A. Hormonal changes in the first 24 postoperative hours after cardiac surgical procedures. Physiol Int 2023; 110:251-266. [PMID: 37540593 DOI: 10.1556/2060.2023.00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 08/06/2023]
Abstract
Background Hormone level changes after heart surgeries are a widely observed phenomenon due to neurohormonal feedback mechanisms that may affect postoperative morbidity and mortality. The current study aimed to analyze the changes in thyroid and sex hormones in the first 24 postoperative hours after heart surgery. Methods This prospective, observational study (registered on ClinicalTrials.gov: NCT03736499; 09/11/2018) included 49 patients who underwent elective cardiac surgical procedures at a tertiary heart center between March 2019 and December 2019. Thyroid hormones, including thyroid-stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4), and sex hormones, including prolactin (PRL) and total testosterone, were measured preoperatively and at 24 h postoperatively. Results Significant decreases in serum TSH (P < 0.001), T3 (P < 0.001) and total testosterone (P < 0.001) levels were noted, whereas T4 (P = 0.554) and PRL (P = 0.616) did not significantly change. Intensive care unit (ICU) hours (P < 0.001), mechanical ventilation (P < 0.001) and Vasoactive-Inotropic Score (VIS) (P = 0.006) were associated with postoperative T3 level. ICU hours were associated with postoperative T4 level (P = 0.028). Postoperative and delta testosterone levels were in connection with lengths of stay in ICU (P = 0.032, P = 0.010 respectively). Model for End-Stage Liver Disease (MELD) scores were associated with thyroid hormone levels and serum testosterone. Conclusions T3 may represent a marker of nonthyroidal illness syndrome and testosterone may reflect hepatic dysfunction. In addition, PRL may act as a stress hormone in female patients.
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Affiliation(s)
- Balázs Szécsi
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Krisztina Tóth
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - András Szabó
- 2Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Csaba Eke
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Rita Szentgróti
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Orsolya Dohán
- 3Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Kálmán Benke
- 4Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Tamás Radovits
- 4Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Miklós Pólos
- 4Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- 4Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - János Gál
- 2Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Andrea Székely
- 2Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
- 5Department of Oxiology and Emergency Care, Semmelweis University, Budapest, Hungary
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Szabó A, Szabó D, Tóth K, Szécsi B, Szentgróti R, Nagy Á, Eke C, Sándor Á, Benke K, Merkely B, Gál J, Székely A. Comprehensive frailty assessment with multidimensional frailty domains as a predictor of mortality among vascular and cardiac surgical patients. Physiol Int 2023. [PMID: 37133997 DOI: 10.1556/2060.2023.00195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 05/04/2023]
Abstract
Purpose The frailty concept has become a fundamental part of daily clinical practice. In this study our purpose was to create a risk estimation method with a comprehensive aspect of patients' preoperative frailty. Patients and methods In our prospective, observational study, patients were enrolled between September 2014 and August 2017 in the Department of Cardiac Surgery and Department of Vascular Surgery at Semmelweis University, Budapest, Hungary. A comprehensive frailty score was built from four main domains: biological, functional-nutritional, cognitive-psychological and sociological. Each domain contained numerous indicators. In addition, the EUROSCORE for cardiac patients and the Vascular POSSUM for vascular patients were calculated and adjusted for mortality. Results Data from 228 participants were included for statistical analysis. A total of 161 patients underwent vascular surgery, and 67 underwent cardiac surgery. The preoperatively estimated mortality was not significantly different (median: 2.700, IQR (interquartile range): 2.000-4.900 vs. 3.000, IQR: 1.140-6.000, P = 0.266). The comprehensive frailty index was significantly different (0.400 (0.358-0.467) vs. 0.348 (0.303-0.460), P = 0.001). In deceased patients had elevated comprehensive frailty index (0.371 (0.316-0.445) vs. 0.423 (0.365-0.500), P < 0.001). In the multivariate Cox model an increased risk for mortality in quartiles 2, 3 and 4 compared with quartile 1 as a reference was found (AHR (95% CI): 1.974 (0.982-3.969), 2.306 (1.155-4.603), and 3.058 (1.556-6.010), respectively). Conclusion The comprehensive frailty index developed in this study could be an important predictor of long-term mortality after vascular or cardiac surgery. Accurate frailty estimation could make the traditional risk scoring systems more accurate and reliable.
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Affiliation(s)
- András Szabó
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Dominika Szabó
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
- 2Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Krisztina Tóth
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Balázs Szécsi
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Rita Szentgróti
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Ádám Nagy
- 3Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Csaba Eke
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Ágnes Sándor
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
- 4Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Kálmán Benke
- 2Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- 2Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - János Gál
- 4Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Andrea Székely
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
- 2Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Eke C, Szabó A, Nagy Á, Szécsi B, Szentgróti R, Dénes A, Kertai MD, Fazekas L, Kovács A, Lakatos B, Hartyánszky I, Benke K, Merkely B, Székely A. Association between Hepatic Venous Congestion and Adverse Outcomes after Cardiac Surgery. Diagnostics (Basel) 2022; 12:diagnostics12123175. [PMID: 36553182 PMCID: PMC9777079 DOI: 10.3390/diagnostics12123175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/03/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Hepatic venous flow patterns reflect pressure changes in the right ventricle and are also markers of systemic venous congestion. Fluid management is crucial in patients undergoing cardiac surgery. METHODS Our goal was to determine which factors are associated with the increased congestion of the liver as measured by Doppler ultrasound in patients undergoing cardiac surgery. This prospective, observational study included 41 patients without preexisting liver disease who underwent cardiac surgery between 1 January 2021 and 30 September 2021 at a tertiary heart center. In addition to routine echocardiographic examination, we recorded the maximal velocity and velocity time integral (VTI) of the standard four waves seen in the common hepatic vein (flow profile) using Doppler ultrasound preoperatively and at the 20-24th hour of the postoperative period. The ratios of the retrograde and anterograde hepatic venous waves were calculated, and the waveforms were compared to the baseline value and expressed as a delta ratio. Demographic data, pre- and postoperative echocardiographic parameters, intraoperative variables (procedure, cardiopulmonary bypass time), postoperative factors (fluid balance, vasoactive medication requirement, ventilation time and parameters) and perioperative laboratory parameters (liver and kidney function tests, albumin) were used in the analysis. RESULTS Of the 41 patients, 20 (48.7%) were males, and the median age of the patients was 65.9 years (IQR: 59.8-69.9 years). Retrograde VTI growth showed a correlation with positive fluid balance (0.89 (95% CI 0.785-0.995) c-index. After comparing the postoperative echocardiographic parameters of the two subgroups, right ventricular and atrial diameters were significantly greater in the "retrograde VTI growth" group. The ejection fraction and decrement in ejection fraction to preoperative parameters were significantly different between the two groups. (p = 0.001 and 0.003). Ventilation times were longer in the retrograde VTI group. The postoperative vs. baseline delta VTI ratio of the hepatic vein correlated with positive fluid balance, maximum central venous pressure, and ejection fraction. (B = -0.099, 95% CI = -0.022-0.002, p = 0.022, B = 0.011, 95% CI = 0.001-0.021, p = 0.022, B = 0.091, 95% CI = 0.052-0.213, p = 0.002, respectively.) Conclusion: The increase of the retrograde hepatic flow during the first 24 h following cardiac surgery was associated with positive fluid balance and the decrease of the right ventricular function. Measurement of venous congestion or venous abdominal insufficiency seems to be a useful tool in guiding fluid therapy and hemodynamic management.
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Affiliation(s)
- Csaba Eke
- Rácz Károly School of PhD Studies, Semmelweis University, Ulloi Ut 26, 1085 Budapest, Hungary
| | - András Szabó
- Rácz Károly School of PhD Studies, Semmelweis University, Ulloi Ut 26, 1085 Budapest, Hungary
| | - Ádám Nagy
- Rácz Károly School of PhD Studies, Semmelweis University, Ulloi Ut 26, 1085 Budapest, Hungary
| | - Balázs Szécsi
- Rácz Károly School of PhD Studies, Semmelweis University, Ulloi Ut 26, 1085 Budapest, Hungary
| | - Rita Szentgróti
- Rácz Károly School of PhD Studies, Semmelweis University, Ulloi Ut 26, 1085 Budapest, Hungary
| | - András Dénes
- Faculty of Medicine, Semmelweis University, Ulloi Ut 26, 1085 Budapest, Hungary
| | - Miklós D. Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Levente Fazekas
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
| | - István Hartyánszky
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
| | - Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
| | - Andrea Székely
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
- Faculty of Health Sciences, Semmelweis University, Vas Utca 17, 1088 Budapest, Hungary
- Correspondence:
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