Cardiopulmonary and systemic effects of methylprednisolone in patients undergoing cardiac surgery.
BACKGROUND
Cardiopulmonary bypass (CPB)-related inflammatory response can be attenuated by glucocorticoid treatment, but its impact on postoperative cardiopulmonary function remains controversial. It was investigated whether the systemic and myocardial antiinflammatory effects of glucocorticoids are associated with improved cardiopulmonary function in cardiac surgery patients.


METHODS
Eighty patients undergoing elective coronary artery bypass grafting were randomly assigned to receive a single shot of methylprednisolone (15 mg/kg) or placebo before CPB. Variables of myocardial and pulmonary function and systemic hemodynamics were measured before and 1, 4, 10, and 24 hours after CPB. Blood was sampled for measurement of proinflammatory (tumor necrosis factor-alpha, interleukin 6, interleukin 8) and antiinflammatory (interleukin 10) cytokines (by enzyme-linked immunoassay), troponin T, and C-reactive protein. Phosphorylation of inhibitory kappa-B alpha and p38 mitogen-activated protein kinase was determined in right atrial biopsies before and after CPB (phosphoprotein assay).


RESULTS
Preoperative and intraoperative characteristics of patients were not different between groups. Methylprednisolone attenuated postoperative tumor necrosis factor-alpha, interleukin 6, interleukin 8, and C-reactive protein levels while increasing interleukin 10 release. Myocardial inhibitory kappa-B alpha was preserved with methylprednisolone (p < 0.05 versus placebo), but p38 mitogen-activated protein kinase activation occurred in both groups after CPB (p < 0.05 versus before CPB). Methylprednisolone improved postoperative cardiac index and was associated with decreased troponin T when compared with placebo (p < 0.05). Postoperative blood glucose, oxygen delivery index, and pulmonary shunt flow were increased in the methylprednisolone group (p < 0.05). There was no difference in postoperative oxygenation index, ventilation time, and clinical outcome between treatment groups.


CONCLUSIONS
Glucocorticoid treatment before CPB attenuates perioperative release of systemic and myocardial inflammatory mediators and improves myocardial function, suggesting potential cardioprotective effects in patients undergoing cardiac surgery.
Liakopoulos
Oliver J
OJ
Department of Thoracic and Cardiovascular Surgery, University of Göttingen, Göttingen, Germany. oliver@liakopoulos.de
Schmitto
Jan D
JD
Kazmaier
Stefan
S
Bräuer
Anselm
A
Quintel
Michael
M
Schoendube
Friedrich A
FA
Dörge
Hilmar
H
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D002097:C-Reactive Protein / Q000032:analysis; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008168:Lung / Q000187:drug effects*; D008297:Male; D008775:Methylprednisolone / Q000494:pharmacology*; D008875:Middle Aged; D016328:NF-kappa B / Q000502:physiology; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood; D048051:p38 Mitogen-Activated Protein Kinases / Q000378:metabolism
D015850:Interleukin-6; D016328:NF-kappa B; D020107:Troponin T; D016753:Interleukin-10; D002097:C-Reactive Protein; D048051:p38 Mitogen-Activated Protein Kinases; D008775:Methylprednisolone