Impact of Intravenous Hydrocortisone on Postoperative Atrial Fibrillation and Outcomes in Patients Receiving Vasopressor Support Following On-Pump Coronary Artery Bypass Grafting
Bibliographic record
Abstract
Background: Although 2019 EACTS Guidelines on Cardiopulmonary Bypass in Adult Cardiac Surgery recommend against routine use of prophylactic corticosteroids, perioperative glucocorticoids are still often used to mitigate hypotension, cardiac arrhythmias and respiratory failure following surgery with cardiopulmonary bypass (CPB). Limited data exists on safety and efficacy of intravenous (IV) hydrocortisone in this setting. Objectives: To assess the impact of intravenous hydrocortisone on postoperative complications after on-pump coronary artery bypass grafting (CABG). Methods: This was a single-center, retrospective chart review between 2021 and 2023. Adult patients with on-pump CABG requiring vasopressor therapy postoperatively were included. Results: Of 153 patients included, 39 received IV hydrocortisone and 114 did not. The hydrocortisone group had significantly lower cortisol levels (15.8 mcg/dL vs 23.9 mcg/dL, P < 0.001) and higher incidence of a past medical history of atrial fibrillation (23.1% vs 2.6%, P < 0.001) compared to the control group. Rates of postoperative atrial fibrillation (POAF) were similar between groups with 23.1% in the hydrocortisone group and 21.9% in the control group ( P = 0.88), which maintained after controlling for age, history of atrial fibrillation, sex, and propensity score ( P = 0.86). Mean cumulative norepinephrine equivalents (NEE) were similar between hydrocortisone group and control (10.4 mcg/min vs 8.9 mcg/min, P = 0.12). Hydrocortisone administration was associated with longer durations of vasopressor therapy (45.8 vs 28.9 hours, P = 0.001), insulin therapy (149.4 vs 82.2 hours, P = 0.003), and total mechanical ventilation time (59.3 vs 19.4 hours, P = 0.049). There were no differences in surgical site infections between the hydrocortisone group versus control group (5.2% vs 5.2%, P = 1.00), including both non-infectious (2.6% vs 2.6%, P = 1.00) and infectious surgical site complications (2.6% vs 2.6%, P = 1.00). Conclusion: After controlling for sex, age, history of atrial fibrillation/flutter, and propensity score, there was no significant association between the administration of IV hydrocortisone and POAF in patients receiving vasopressor support following on-pump CABG. Further prospective studies are needed to confirm these findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".