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Randomized Controlled Trial
. 2016 Mar;26(3):506-15.
doi: 10.1017/S1047951115000566. Epub 2015 Apr 28.

Effect of steroids on inflammatory markers and clinical parameters in congenital open heart surgery: a randomised controlled trial

Muhammad M Amanullah  1 , Mohammad Hamid  2 , Hashim M Hanif  1 , Marium Muzaffar  1 , Maria T Siddiqui  1 , Fatima Adhi  1 , Khabir Ahmad  1 , Shahjahan Khan  3 , Zahra Hasan  4
Affiliations
Randomized Controlled Trial

Effect of steroids on inflammatory markers and clinical parameters in congenital open heart surgery: a randomised controlled trial

Muhammad M Amanullah et al. Cardiol Young. 2016 Mar.

Abstract

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.

Materials and 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.

Conclusion: 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.

Keywords: Cardiopulmonary bypass; congenital heart disease; inflammatory markers; steroids.

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