Association between stress hormones and perioperative risk in patients with critical limb ischemia undergoing revascularization.

BACKGROUND: It is well known that the clinical outcome of patients with critical limb ischemia (CLI) is poor. However, the relationship between stress-related hormone levels and CLI outcome remains unclear. The aim of this study was to reveal the association of stress hormones with the risk of a perioperative major adverse cardiovascular event (pMACE) in CLI patients undergoing surgical and endovascular revascularization.

METHODS: The study analyzed 467 CLI patients who had levels of stress-related hormones (epinephrine, norepinephrine, dopamine, and cortisol) measured before undergoing revascularization. The primary end point was pMACE, including all-cause mortality, myocardial infarction, and stroke within 30 days after revascularization. Propensity score matching was used to try to control for potential confounding.

RESULTS: Of the 467 patients analyzed, pMACE was observed in 21 patients (4.5%). The crude comparison of stress-related hormone levels between those with and those without pMACE showed that those with pMACE had a higher level of epinephrine, dopamine, and cortisol compared with those without pMACE. After propensity matching (20 patients with pMACE and 192 patients without pMACE), epinephrine and cortisol levels were significantly higher in those with pMACE. Multivariate analysis confirmed that both epinephrine and cortisol levels were related to the risk of pMACE independently of each other. The Cox proportional hazards regression model demonstrated that both hormones were associated with 30-day mortality but not with longer term mortality.

CONCLUSIONS: Stress-related hormone (epinephrine and cortisol) levels were significantly associated with the risk of pMACE in CLI patients undergoing revascularization. Both hormones were related to 30-day mortality.