Analysis of the Relationships between Multiple Endocrine Hormones and Return of Spontaneous Circulation (ROSC) in Cardiac Arrest Patients: Possible Association of the Serum Free T4 Level with ROSC.

Go Koizumi,Shoichiro Nagasaka,Kei Endo,Kentaro Mikura,Yasuyoshi Kigawa,Mai Hashizume,Fumiko Otsuka,Ryo Saiki,Tatsuya Iida,Munetaka Hayashi,Mariko Kaji,Norimitsu Murai,Jun Sasaki,Toru Iizaka,Flavia Prodam

doi:10.1155/2020/4168420

Go Koizumi, Shoichiro Nagasaka + Show 13 more

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https://doi.org/10.1155/2020/4168420

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Abstract

Background Endocrine hormones are closely associated with homeostasis, so it is important to clarify hormone secretion dynamics in shock. Few reports, however, have examined the dynamics of endogenous hormone secretion relative to prognosis in cardiac arrest patients. Therefore, to clarify the roles of endocrine hormones in out-of-hospital cardiac arrest (OHCA) patients, the concentrations of anterior pituitary, thyroid, and adrenocortical hormones were measured, and their associations with return of spontaneous circulation (ROSC) were examined. Methods The subjects were OHCA patients transported to our Emergency Department. In addition to conventional clinical laboratory tests, the following were measured: serum TSH, serum free T3, serum free T4 (F-T4), plasma ACTH, serum cortisol, serum GH, serum IGF-1, plasma aldosterone concentration (PAC), and plasma renin activity. The primary endpoint was the presence or absence of ROSC, and the secondary endpoint was 24-hour survival. Results A total of 29 patients, 17 in the ROSC group and 12 in the non-ROSC group, were studied. There were associations between ROSC and low serum potassium, high F-T4, low cortisol, and low PAC on bivariate analyses. There were associations between ROSC and serum potassium, F-T4, and GH using the step-wise method. On multiple logistic regression analysis, a relationship between ROSC and high serum F-T4 level was identified by both methods. There were also associations between 24-hour survival and both low serum potassium and elevated blood glucose levels. Conclusions The present findings suggest a possible relationship between the serum F-T4 level and ROSC in OHCA patients. A higher serum F-T4 level might cause an increase in the β-adrenergic response in cardiomyocytes and increased responsiveness to catecholamines and was possibly associated with ROSC.

Highlights

Adrenaline is currently administered to improve cardiac arrest patient outcomes in countries around the world
Tsai et al reported that, in a nonrandomized, open-label, clinical study in which hydrocortisone or International Journal of Endocrinology placebo was administered to endogenous of-hospital cardiac arrest (OHCA) patients, an improvement in the return of spontaneous circulation (ROSC) rate was found in the group treated with hydrocortisone, no significant differences were found in survival or hospital discharge rates [4]
Endocrine hormones are closely related to homeostasis, such as blood pressure, body fluids and electrolytes, and blood glucose levels, and it is important to clarify the dynamics of hormone secretion during shock. ere have been reports investigating the circulating levels of cortisol and catecholamines in cardiac arrest patients and their prognosis. ese reports stated that the circulating levels of adrenaline/noradrenaline were significantly lower in the ROSC group [5] and that no difference in serum cortisol levels was found between ROSC and non-ROSC groups [6]

Summary

Background

Endocrine hormones are closely associated with homeostasis, so it is important to clarify hormone secretion dynamics in shock. Few reports have examined the dynamics of endogenous hormone secretion relative to prognosis in cardiac arrest patients. Erefore, to clarify the roles of endocrine hormones in out-of-hospital cardiac arrest (OHCA) patients, the concentrations of anterior pituitary, thyroid, and adrenocortical hormones were measured, and their associations with return of spontaneous circulation (ROSC) were examined. Ere were associations between ROSC and low serum potassium, high F-T4, low cortisol, and low PAC on bivariate analyses. Ere were associations between ROSC and serum potassium, F-T4, and GH using the step-wise method. On multiple logistic regression analysis, a relationship between ROSC and high serum F-T4 level was identified by both methods. Ere were associations between 24hour survival and both low serum potassium and elevated blood glucose levels. E present findings suggest a possible relationship between the serum F-T4 level and ROSC in OHCA patients. A higher serum F-T4 level might cause an increase in the β-adrenergic response in cardiomyocytes and increased responsiveness to catecholamines and was possibly associated with ROSC

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