Preoperative methylprednisolone administration maintains coagulation homeostasis in patients undergoing liver resection: importance of inflammatory cytokine modulation.
Alterations in hemostatic parameters are a common finding after major hepatic resection. There is growing evidence that inflammation has a significant role in inducing coagulation disarrangement that follows major surgery. To determine whether preoperative methylprednisolone administration has a protective effect against the development of coagulation disorders, we evaluated the effect of preoperative steroids administration on changes in hemostatic parameters and plasma levels of inflammatory cytokines in patients undergoing liver surgery. Seventy-three patients undergoing liver resection were randomized to a steroid group or to a control group. Patients in the steroid group received 500 mg of methylprednisolone preoperatively. Serum levels of coagulation parameters (prothrombin time, platelets, fibrinogen, plasma fibrin degradation products [D-dimer], antithrombin III) and inflammatory mediators (IL-6 and TNF-alpha) were measured before and immediately after the operation and on postoperative days 1, 2, and 5. Multivariate analysis was performed to identify factors related to the characteristics of the patients and surgery affecting coagulation parameters between the two groups. Decreases in antithrombin III, platelet count and fibrinogen levels, prolongation of prothrombin time, and increases in the plasma fibrin degradation products were significantly suppressed by the administration of methylprednisolone. Cytokines production was also significantly suppressed by the administration of methylprednisolone, and there was significant correlation between plasma levels of cytokines and coagulation alterations. These findings suggest that preoperative methylprednisolone administration inhibits the development of coagulation disarrangements in patients undergoing liver resection, possibly through suppressing the production of inflammatory cytokines.
Pulitanò
Carlo
C
Department of Surgery-Liver Unit, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy. pulitano.carlo@hsr.it
Aldrighetti
Luca
L
Arru
Marcella
M
Finazzi
Renato
R
Catena
Marco
M
Guzzetti
Eleonora
E
Soldini
Laura
L
Comotti
Laura
L
Ferla
Gianfranco
G
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology; D000990:Antithrombin III / Q000378:metabolism; D001777:Blood Coagulation / Q000187:drug effects*; D016207:Cytokines / Q000097:blood*; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D006498:Hepatectomy; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008775:Methylprednisolone / Q000008:administration & dosage / Q000494:pharmacology*; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D016207:Cytokines; D005338:Fibrin Fibrinogen Degradation Products; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D000990:Antithrombin III; D005340:Fibrinogen; D008775:Methylprednisolone