eprintid: 1569762
rev_number: 58
eprint_status: archive
userid: 608
dir: disk0/01/56/97/62
datestamp: 2017-08-15 16:38:15
lastmod: 2021-10-04 01:07:46
status_changed: 2017-08-15 16:38:15
type: article
metadata_visibility: show
creators_name: Khoo, B
creators_name: Boshier, PR
creators_name: Freethy, A
creators_name: Tharakan, G
creators_name: Saeed, S
creators_name: Hill, N
creators_name: Williams, EL
creators_name: Moorthy, K
creators_name: Tolley, N
creators_name: Jiao, LR
creators_name: Spalding, D
creators_name: Palazzo, F
creators_name: Meeran, K
creators_name: Tan, T
title: Re-defining the stress cortisol response to surgery
ispublished: pub
divisions: UCL
divisions: B02
divisions: C10
divisions: D17
divisions: G93
keywords: Cortisol, Cortisol Binding Globulin, Stress Response, Surgery
note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
abstract: BACKGROUND: Cortisol levels rise with the physiological stress of surgery. Previous studies have used older, less-specific assays, have not differentiated by severity, or only studied procedures of a defined type. The aim of this study was to examine this phenomenon in surgeries of varying severity using a widely used cortisol immunoassay. METHODS: Euadrenal patients undergoing elective surgery were enrolled prospectively. Serum samples were taken at 8 am on surgical day, induction and 1 hr, 2 hr, 4 hr and 8 hr after. Subsequent samples were taken daily at 8 am until post-operative day 5 or hospital discharge. Total cortisol was measured using an Abbott Architect immunoassay, and cortisol binding globulin (CBG) using a radioimmunoassay. Surgical severity was classified by POSSUM operative severity score. RESULTS: 93 patients underwent surgery: Major/Major+ (n=37), Moderate (n=33), and Minor (n=23). Peak cortisol positively correlated to severity: Major/Major+ median 680 [range 375-1452], Moderate 581 [270-1009], and Minor 574 [272-1066] nmol/L (Kruskal-Wallis test, P=0.0031). CBG fell by 23%; the magnitude of the drop positively correlated to severity. CONCLUSIONS: The range in baseline and peak cortisol response to surgery is wide, and peak cortisol levels lower than previously appreciated. Improvements in surgery, anaesthetic techniques, and cortisol assays might explain our observed lower peak cortisols. The criteria for the dynamic testing of cortisol response may need to be reduced to take account of these factors. Our data also support a lower-dose, stratified approach to dosing of steroid replacement in hypoadrenal patients, to minimise the deleterious effects of over-replacement.
date: 2017-11
date_type: published
official_url: http://doi.org/10.1111/cen.13439
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1412981
doi: 10.1111/cen.13439
lyricists_name: Khoo, Bernard
lyricists_id: BKHOO30
actors_name: Waragoda Vitharana, Nimal
actors_id: NWARR44
actors_role: owner
full_text_status: public
publication: Clinical Endocrinology
volume: 87
number: 5
pagerange: 451-458
event_location: England
issn: 1365-2265
citation:        Khoo, B;    Boshier, PR;    Freethy, A;    Tharakan, G;    Saeed, S;    Hill, N;    Williams, EL;                             ... Tan, T; + view all <#>        Khoo, B;  Boshier, PR;  Freethy, A;  Tharakan, G;  Saeed, S;  Hill, N;  Williams, EL;  Moorthy, K;  Tolley, N;  Jiao, LR;  Spalding, D;  Palazzo, F;  Meeran, K;  Tan, T;   - view fewer <#>    (2017)    Re-defining the stress cortisol response to surgery.                   Clinical Endocrinology , 87  (5)   pp. 451-458.    10.1111/cen.13439 <https://doi.org/10.1111/cen.13439>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/1569762/1/Khoo_Cortisol%20in%20Surgery%20Paper%20170724%20Accepted%20Version.pdf
document_url: https://discovery.ucl.ac.uk/id/eprint/1569762/6/Khoo_Figure1.pdf
document_url: https://discovery.ucl.ac.uk/id/eprint/1569762/14/Khoo_figure2.pdf
document_url: https://discovery.ucl.ac.uk/id/eprint/1569762/19/Khoo_figure3.pdf
document_url: https://discovery.ucl.ac.uk/id/eprint/1569762/26/Khoo_figure4.pdf