Role of Sex Hormones in Neurocognitive Decline after Cardiac Surgery
*Madigan Stanley, *Danielle Sawka, Afshin Ehsan, Neel Sodha, Frank Sellke
Department of Surgery, Brown University, Providence, RI, United States.
Background: Neurocognitive decline (NCD) after cardiac surgery is a common complication and has critical implications for outcomes and quality of life. Female patients have a higher incidence and greater severity of NCD after cardiac surgery. We aimed to investigate whether sex hormones play a role in this difference.
Study Design: This was a retrospective study or a prospectively enrolled cohort at a single academic center. Sex hormone testing was performed using enzyme linked immunosorbent assays on preoperative plasma samples from 32 male and 30 female patients who had undergone cardiac surgery. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to measure neurocognitive function preoperatively and on postoperative day four for all patients. Scores are scaled against normative data published by the manufacturer. A t-test or Mann-Whitney U test was applied as appropriate to test if sex hormone concentrations differed significantly among patients with and without NCD.
Results: 62 patients underwent cardiac surgery and completed pre-operative and post-operative day four neurocognitive testing (48.4% female). As expected, 8/32 (25.0%) male patients versus 21/30 (70.0%) female patients had NCD. Both cohorts were similar in age (Male M=66.8, SD 8.9 vs Female=66.5, SD 7.3; p=0.87. In general, concentrations of sex hormones differed as follows between males and post-menopausal females: higher beta-estradiol levels among males (p=0.009), similar progesterone among males and females, and higher testosterone among males (p<0.001). Notably, men without NCD tended to have higher progesterone levels (p=0.01); there was no difference in mean age for the men with and without NCD (p=0.09). There was no strong correlation between progesterone level and NCD status in female patients (p=0.64). Neither beta-estradiol nor testosterone levels were significantly correlated with RBANS score change, or NCD incidence, in either male or female patients. Among all patients, testosterone levels tended to be lower for those with NCD.
Conclusions: There appears to be a strong non age-dependent association between higher progesterone levels in men without versus with postoperative NCD. No relationships were found between sex hormone levels and NCD status in female patients. Sex hormone assessment and optimization may play an important role in improving functional cognitive outcomes.
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