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Salivary Cortisol as a Predictor of Postoperative Fatigue

From the Section of General Hospital Psychiatry, Division of Psychological Medicine, Institute of Psychiatry and Guy’s, King’s and St. Thomas’ School of Medicine, King’s College London, London, UK (G.J.R., M.H., A.C.); the Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK (G.J.R., A.C.); and the Affective Disorders Unit, Bethlem Royal Hospital, South London and Maudsely NHS Trust, London, UK (A.P., A.C.).

Address correspondence and reprint requests to G. James Rubin, PhD, Section of General Hospital Psychiatry (PO62), Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. E-mail: g.rubin{at}iop.kcl.ac.uk

Objective: Some patients with chronic fatigue syndrome (CFS) exhibit low basal cortisol levels, but it is not known whether low cortisol is a cause of CFS, predates the onset of CFS symptoms, or is an epiphenomenon caused by the behavioral changes typical of CFS. Because elective surgery is one of the few predictable risk factors for chronic fatigue, in this study, we followed a cohort of surgery patients from before to 6 months after their operation to test these theories.

Method: One hundred sixty-one patients completed fatigue questionnaires and provided salivary cortisol samples before undergoing an elective inpatient surgical procedure, and then 2 days, 3 weeks, and 6 months afterward.

Results: Controlling for relevant demographic and surgical variables and for preoperative fatigue, low preoperative cortisol did not predict postoperative fatigue severity on any occasion (p > .05). Similarly, there was no correlation between low postoperative cortisol and postoperative fatigue severity at 3 weeks or 6 months (p > .05). Although 16 patients met our case definition for "chronic fatigue" at the 6-month follow up, low preoperative and low postoperative cortisol did not significantly predict fatigue caseness (p > .05).

Conclusions: Any association between chronic fatigue and low cortisol would seem to develop after the onset of fatigue symptoms. Low cortisol is therefore unlikely to be the primary cause of chronic fatigue states.

Key Words: cortisol • fatigue • chronic fatigue syndrome • surgery • HPA axis • adrenal function

Abbreviations: AuC= area under the curve; ASA = American Society of Anesthesiologists physical status score; CBT = cognitive behavioral therapy; CFS = chronic fatigue syndrome; MD = mean difference; T1 = before surgery; T2 = 2 days after surgery; T3 = 3 weeks after surgery; T4 = 6 months after surgery.

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