Dexamethasone prophylaxis in pediatric open heart surgery is associated with increased blood long pentraxin PTX3: potential clinical implications

Abstract

Glucocorticoid administration before cardiopulmonary bypass (CPB) can reduce the systemic inflammatory response and improve clinical outcome. Long pentraxin PTX3 is a novel inflammatory parameter that could play a protective cardiovascular role by regulating inflammation. Twenty-nine children undergoing open heart surgery were enrolled in the study. Fourteen received dexamethasone (1st dose 1.5 mg/Kg i.v. or i.m. the evening before surgery; 2nd dose 1.5 mg/kg i.v. before starting bypass) and fifteen children served as control. Blood PTX3, short pentraxin C-reactive protein (CRP), interleukin-1 receptor II (IL-1RII), fibrinogen and partial thromboplastin time (PTT) were assayed at different times. PTX3 levels significantly increased during CPB in dexamethasone-treated (+D) and dexamethasone-untreated (-D) subjects, but were significantly higher in +D than -D patients. CRP levels significantly increased both in +D and -D patients in the postoperative days, with values significantly higher in -D than +D patients. Fibrinogen and PTT values were significantly higher in -D than +D patients in the 1st postoperative day. IL-1RII plasma levels increased in the postoperative period in both groups. Dexamethasone prophylaxis in pediatric patients undergoing CPB for cardiac surgery is associated with a significant increase of blood PTX3 that could contribute to decreasing inflammatory parameters and improving patient clinical outcome.

Figure 1

Plasma levels of PTX3 (a) and soluble IL1 receptor II (b) in pediatric patients undergoing CPB, either treated or untreated with dexamethasone. Values are expressed as medians and 1st and 3rd quartile. Time of blood sampling: T1, preoperative, before steroid administration; T2, 10 min after CPB; T3, after aortic declamping; T4, at the end of CPB; T5, 1st postoperative day; T6, 2nd postoperative day.***P < 0.001.

Figure 2

Plasma levels of CRP (a) and fibrinogen (b), and PTT values (c) in children undergoing CPB, either treated or untreated with dexamethasone. Values are expressed as medians and 1st and 3rd quartile. Time points are defined in Figure 1. ***P < 0.001; **P < 0.01; *P < 0.05.