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