Effect of steroids on inflammatory markers and clinical parameters in congenital open heart surgery: a randomised controlled trial.
BACKGROUND
Cardiopulmonary bypass is associated with systemic inflammatory response. Steroids suppress this response, although the therapeutic evidence remains controversial. We hypothesised that intravenous steroids in children undergoing open-heart surgery would decrease inflammation leading to better early post-operative outcomes. We conducted a randomised controlled trial to evaluate the trends in the levels of immunomodulators and their effects on clinical parameters.


OBJECTIVE
To assess the effects of intravenous steroids on early post-operative inflammatory markers and clinical parameters in children undergoing open-heart surgery.


METHODS
A randomised controlled trial involving 152 patients, from one month up to 18 years of age, who underwent open-heart surgery for congenital heart disease from April 2010-2012 was carried out. Patients were randomised and administered either three scheduled intravenous pulse doses of dexamethasone (1 mg/kg) or placebo. Blood samples were drawn at four time intervals and serum levels of inflammatory cytokines - Interleukin-6, 8, 10, 18, and tumour necrosis factor-alpha - were measured. Clinical parameters were also assessed.


RESULTS
Blood cytokine levels were compared between the dexamethasone (n=65) and placebo (n=64) groups. Interleukin-6 levels were lower at 6 and 24 hours post-operatively (p<0.001), and Interleukin-10 levels were higher 6 hours post-operatively (p<0.001) in the steroid group. Interleukin-8, 18, and tumour necrosis factor-alpha levels did not differ between the groups at any time intervals. The clinical parameters were similar in both the groups.


CONCLUSIONS
Dexamethasone caused quantitative suppression of Interleukin-6 and increased Interleukin-10 activation, contributing to reduced immunopathology, but it did not translate into clinical benefit in the short term.
1Department of Surgery,AKUH,Karachi,Pakistan.
Muhammad M
MM
Amanullah
2Department of Cardiac Anaesthesia,AKUH,Karachi,Pakistan.
Mohammad
M
Hamid
1Department of Surgery,AKUH,Karachi,Pakistan.
Hashim M
HM
Hanif
1Department of Surgery,AKUH,Karachi,Pakistan.
Marium
M
Muzaffar
1Department of Surgery,AKUH,Karachi,Pakistan.
Maria T
MT
Siddiqui
1Department of Surgery,AKUH,Karachi,Pakistan.
Fatima
F
Adhi
1Department of Surgery,AKUH,Karachi,Pakistan.
Khabir
K
Ahmad
3Medical College,Agha Khan University,AKUH,Karachi,Pakistan.
Shahjahan
S
Khan
4Department of Pathology and Microbiology,AKUH,Karachi,Pakistan.
Zahra
Z
Hasan
D061605:Administration, Intravenous; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000628:therapy*; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000097:blood* / Q000517:prevention & control; D008297:Male; D010154:Pakistan; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
D015415:Biomarkers; D016207:Cytokines; D014409:Tumor Necrosis Factor-alpha; D003907:Dexamethasone
Cardiopulmonary bypass; congenital heart disease; inflammatory markers; steroids