Key result
Deficient HPA-axis function in patients undergoing abdominal surgery was associated with significantly reduced factor VIII levels (P=0.049), indicating impaired hemostasis.
Why the study?
Data were lacking regarding the impact of adrenal function on hemostasis and endothelial function in the perioperative setting.
Does deficient HPA-axis function impair hemostasis and endothelial function in patients undergoing abdominal surgery?
Observational (n=60)
No
Does deficient HPA-axis function impair hemostasis and endothelial function in patients undergoing abdominal surgery?
Patients with deficient HPA-axis function undergoing abdominal surgery demonstrate impaired hemostasis, specifically reduced Factor VIII, which may increase bleeding risk.
May signal higher perioperative bleeding risk; leaves open whether HPA-axis support improves hemostasis.
CONTEXT: Glucocorticoids regulate hemostatic and endothelial function, and they are critical for adaptive functions during surgery. No data regarding the impact of adrenal function on hemostasis and endothelial function in the perioperative setting are available. OBJECTIVE: We assessed the association of adrenal response to adrenocorticotropic hormone (ACTH) and markers of endothelial/hemostatic function in surgical patients. METHODS: This prospective observational study, conducted at a tertiary care hospital, included 60 patients (35 male/25 female) undergoing abdominal surgery. Adrenal function was evaluated by low-dose ACTH stimulation test on the day before, during, and the day after surgery. According to their stimulated cortisol level (cutoff ≥ 500 nmol/L), patients were classified as having normal hypothalamic-pituitary-adrenal (HPA)-axis function (nHPA) or deficient HPA-axis function (dHPA). Parameters of endothelial function (soluble vascular cell adhesion molecule-1, thrombomodulin) and hemostasis (fibrinogen, von Willebrand factor antigen, factor VIII [FVIII]) were measured during surgery. FVIII was significantly reduced in patients with dHPA in uni- and multivariable analyses; other factors displayed no significant differences. Coagulation factors/endothelial markers changed progressively in relation to stimulated cortisol levels and showed a turning point at cortisol levels between 500 and 600 nmol/L. CONCLUSIONS: Patients with dHPA undergoing abdominal surgery demonstrate impaired hemostasis which can translate into excessive blood loss.
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Fischli et al. (2021) conducted an observational in Abdominal surgery (n=60). Deficient HPA-axis function (dHPA) vs. Normal HPA-axis function (nHPA) was evaluated on Factor VIII (FVIII) levels (p=0.049). Deficient HPA-axis function in patients undergoing abdominal surgery was associated with significantly reduced factor VIII levels (P=0.049), indicating impaired hemostasis.
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