Neuroendocrine predictors of vasoplegia after cardiopulmonary bypass
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ORIGINAL ARTICLE
Neuroendocrine predictors of vasoplegia after cardiopulmonary bypass D. Pasero1 · A. M. Berton2 · G. Motta2 · R. Raffaldi3 · G. Fornaro4 · A. Costamagna4 · A. Toscano4 · C. Filippini3 · G. Mengozzi5 · N. Prencipe2 · M. Zavattaro2 · F. Settanni2 · E. Ghigo2 · L. Brazzi3,4 · A. S. Benso2 Received: 4 July 2020 / Accepted: 9 November 2020 © The Author(s) 2020
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 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
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