title: Effect of high-dose dexamethasone on perioperative lactate levels and glucose control: a randomized controlled trial.
abstract: BACKGROUND
  Blood lactate levels are increasingly used to monitor patients. Steroids are frequently administered to critically ill patients. However, the effect of steroids on lactate levels has not been adequately investigated. We studied the effect of a single intraoperative high dose of dexamethasone on lactate and glucose levels in patients undergoing cardiac surgery.
  
  
  METHODS
  The Dexamethasone for Cardiac Surgery (DECS) trial was a multicenter randomized trial on the effect of dexamethasone 1 mg/kg versus placebo on clinical outcomes after cardiac surgery in adults. Here we report a pre-planned secondary analysis of data from DECS trial participants included at the University Medical Center Groningen. The use of a computer-assisted glucose regulation protocol--Glucose Regulation for Intensive care Patients (GRIP)--was part of routine postoperative care. GRIP aimed at glucose levels of 4 to 8 mmol/L. Primary outcome parameters were area under the lactate and glucose curves over the first 15 hours of ICU stay (AUC₁₅). ICU length of stay and mortality were observed as well.
  
  
  RESULTS
  The primary outcome could be determined in 497 patients of the 500 included patients. During the first 15 hours of ICU stay, lactate and glucose levels were significantly higher in the dexamethasone group than in the placebo group: lactate AUC₁₅ 25.8 (13.1) versus 19.9 (11.2) mmol/L × hour, P <0.001 and glucose AUC₁₅ 126.5 (13.0) versus 114.4 (13.9) mmol/L × hour, P <0.001. In this period, patients in the dexamethasone group required twice as much insulin compared with patients who had received placebo. Multivariate and cross-correlation analyses suggest that the effect of dexamethasone on lactate levels is related to preceding increased glucose levels. Patients in the placebo group were more likely to stay in the ICU for more than 24 hours (39.2%) compared with patients in the dexamethasone group (25.0%, P = 0.001), and 30-day mortality rates were 1.6% and 2.4%, respectively (P = 0.759).
  
  
  CONCLUSIONS
  Intraoperative high-dose dexamethasone increased postoperative lactate and glucose levels in the first 15 hours of ICU stay. Still, patients in the dexamethasone group had a shorter ICU length of stay and similar mortality compared with controls.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00293592 . Registered 16 February 2006.
authors.affiliation: Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Mail stop Q.04.2.313, PO Box 85500, Utrecht, 3508, GA, The Netherlands. t.h.ottens@umcutrecht.nl.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Ottens
authors.affiliation: Department of Critical Care, University Medical Center, University of Groningen, Hanzeplein 1, Groningen, RB, 9700, The Netherlands. m.w.n.nijsten@umcg.nl.
authors.forename: Maarten W N
authors.initials: MW
authors.lastname: Nijsten
authors.affiliation: Department of Anesthesiology, Erasmus University Medical Center, 's Gravendijkwal 230, Rotterdam, CE, 3015, The Netherlands. j.hofland1@erasmusmc.nl.
authors.forename: Jan
authors.initials: J
authors.lastname: Hofland
authors.affiliation: Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Mail stop Q.04.2.313, PO Box 85500, Utrecht, 3508, GA, The Netherlands. s.dieleman@umcutrecht.nl.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Dieleman
authors.affiliation: Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, RB, 9700, The Netherlands. m.hoekstra01@umcg.nl.
authors.forename: Miriam
authors.initials: M
authors.lastname: Hoekstra
authors.affiliation: Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Mail stop Q.04.2.313, PO Box 85500, Utrecht, 3508, GA, The Netherlands. d.vandijk@umcutrecht.nl.
authors.forename: Diederik
authors.initials: D
authors.lastname: van Dijk
authors.affiliation: Department of Critical Care, University Medical Center, University of Groningen, Hanzeplein 1, Groningen, RB, 9700, The Netherlands. j.van.der.maaten@umcg.nl.|Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, RB, 9700, The Netherlands. j.van.der.maaten@umcg.nl.
authors.forename: Joost Maa
authors.initials: JM
authors.lastname: van der Maaten
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002315:Cardiopulmonary Bypass; D016638:Critical Illness; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007362:Intensive Care Units; D007430:Intraoperative Care; D019344:Lactic Acid / Q000097:blood*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D000067716:Point-of-Care Testing
chemical_list: D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D019344:Lactic Acid; D003907:Dexamethasone