Influence of dextran-70 on systemic inflammatory response and myocardial ischaemia-reperfusion following cardiac operations.
BACKGROUND
Experimental studies have demonstrated that dextran-70 reduces the leukocyte-endothelium interaction, but clinical evidence is still lacking. Our objective was to justify the anti-inflammatory effect of dextran-70 following cardiac operations.


METHODS
Forty patients undergoing coronary bypass surgery (n = 32) or aortic valve replacement (n = 8) were enrolled in this prospective, randomized, double-blind study. Two groups were formed. In group A (n = 20), dextran-70 infusion was administered at a dose of 7.5 ml/kg before the initiation of cardiopulmonary bypass and at a dose of 12.5 ml/kg after the cessation of cardiopulmonary bypass. Group B served as a control with identical amounts of gelatin infusion (n = 20). The plasma concentration of procalcitonin, C-reactive protein, IL 6, IL 6r, IL 8, IL 10, soluble endothelial leukocyte adhesion molecule-1, soluble intercellular adhesion molecule-1, cardiac troponin-I and various haemodynamic parameters were measured in the perioperative period. Multivariate methods were used for statistical analysis.


RESULTS
In group A, lower peak (median) plasma levels of procalcitonin (0.2 versus 1.4, p < 0.001), IL 8 (5.6 versus 94.8, p < 0.001), IL 10 (47.2 versus 209.7, p = 0.001), endothelial leukocyte adhesion molecule-1 (88.5 versus 130.6, p = 0.033), intercellular adhesion molecule-1 (806.7 versus 1,375.7, P = 0.001) and troponin-I (0.22 versus 0.66, p = 0.018) were found. There was no significant difference in IL 6, IL-6r and C-reactive protein values between groups. Higher figures of the cardiac index (p = 0.010) along with reduced systemic vascular resistance (p = 0.005) were noted in group A.


CONCLUSIONS
Our investigation demonstrated that the use of dextran-70 reduces the systemic inflammatory response and cardiac troponin-I release following cardiac operation.


BACKGROUND
ISRCTN38289094.
Gombocz
Károly
K
Zala County Hospital, Department of Cardiac Surgery, University of Pécs, Zalaegerszeg, Hungary. gomboczk@freemail.hu
Beledi
Agnes
A
Alotti
Nasri
N
Kecskés
Gábor
G
Gábor
Valéria
V
Bogár
Lajos
L
Koszegi
Tamás
T
Garai
János
J
D000925:Anticoagulants / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003911:Dextrans / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood
D000925:Anticoagulants; D015415:Biomarkers; C000606589:CALCA protein, human; D003911:Dextrans; D016209:Interleukin-8; D011498:Protein Precursors; D018799:Intercellular Adhesion Molecule-1; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
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