title: Steroid therapy attenuates acute phase reactant response among children on ventricular assist device support.
abstract: BACKGROUND
  Hyperfibrinogenemia, which can create a procoagulant milieu, is frequently observed in patients supported with the Berlin EXCOR (Berlin Heart GmbH, Berlin, Germany) ventricular assist device (VAD). We began initiating corticosteroids in patients with systemic inflammatory response syndrome (SIRS) episodes to mitigate hyperfibrinogenemia. We set forth to describe the impact of corticosteroids on the hyperfibrinogenemic state in our institutional experience.
  
  
  METHODS
  Retrospective data was collected on 44 consecutive patients implanted with the Berlin EXCOR VAD from April 15, 2005 through May 6, 2013. Pertinent information was abstracted from the electronic medical record. The reduction of C-reactive protein (CRP) and fibrinogen levels among days from corticosteroid treatment were described. Infections and insulin use were reported based on whether patients received steroids and if steroids were given for SIRS.
  
  
  RESULTS
  Over the initial 44 Berlin EXCOR VAD implantations, 14 patients were treated with 21 courses of corticosteroids for SIRS episodes as identified by clinical features and rise in CRP. Treatment with corticosteroids reduced fibrinogen levels by day 2 to a statistically significant degree (p = 0.008). No difference in hyperglycemia or infections occurred among patients receiving corticosteroids for SIRS.
  
  
  CONCLUSIONS
  Treatment with corticosteroids can potentially mitigate the SIRS response among children supported on the Berlin EXCOR VAD. In patients who received corticosteroids to mitigate inflammation, there was no increase in infections or hyperglycemia requiring insulin administration compared with patients who did not receive steroids.
authors: Department of Pediatrics, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio.
authors: Jonathan W
authors: JW
authors: Byrnes
authors: Department of Pediatrics, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; Department of Pediatrics, University of Maryland, Baltimore, Maryland.
authors: Adnan T
authors: AT
authors: Bhutta
authors: Department of Biostatistics, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors: Mallikarjuna Rao
authors: MR
authors: Rettiganti
authors: College of Medicine, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors: Alberto
authors: A
authors: Gomez
authors: Department of Pediatrics, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors: Xiomara
authors: X
authors: Garcia
authors: Department of Pediatrics, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; Department of Pediatrics, Comer Children's Hospital, Chicago, Illinois.
authors: Umesh
authors: U
authors: Dyamenahalli
authors: Department of Surgery, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors: Charles
authors: C
authors: Johnson
authors: Department of Surgery, Duke University, Durham, North Carolina.
authors: Robert D B
authors: RD
authors: Jaquiss
authors: Department of Surgery, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors: Michiaki
authors: M
authors: Imamura
authors: Department of Pediatrics, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas. Electronic address: prodhanparthak@uams.edu.
authors: Parthak
authors: P
authors: Prodhan
mesh_terms: D000209:Acute-Phase Proteins / Q000187:drug effects / Q000378:metabolism*; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005340:Fibrinogen / Q000187:drug effects / Q000378:metabolism; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D005340:Fibrinogen; D002097:C-Reactive Protein