Effects of postoperative glucocorticoids on mitigation of organ dysfunction in patients with type A aortic dissection: a randomized controlled trial

Abstract

Objectives: This study aims to evaluate the organ-protective efficacy of postoperative glucocorticoid in patients with type A aortic dissection.

Methods: Postoperative type A aortic dissection patients were randomly allocated to receive either postoperative glucocorticoid or standard-of-care treatment. Intravenous methylprednisolone was administered for 3 days. The primary outcome was the reduction of Sequential Organ Failure Assessment score on postoperative day 4 compared to baseline (on postoperative day 1 before methylprednisolone administration).

Results: Two hundred twelve patients were included in the intention-to-treat analysis. The primary outcome was significantly different between groups: 3.16 ± 2.52 in the control group versus 4.36 ± 2.82 in the glucocorticoid group (absolute difference 1.20 [95% CI 0.52-1.93], P = 0.001). The glucocorticoid group showed markedly lower median high-sensitivity C-reactive protein levels compared to the control group (91.0 mg/l vs 182.0 mg/l; absolute difference: -91 (95% CI -122 to -57), P = 0.009) on postoperative day 4. Fewer patients in the glucocorticoid group required continuous renal replacement therapy (8.5% vs 19.8% in the control group; absolute difference: -10.4 [95% CI -19.1 to -1.3], P = 0.03).

Conclusions: This trial demonstrates that postoperative glucocorticoid in patients with type A aortic dissection significantly reduces postoperative inflammation and improves recovery of early organ dysfunction. These findings advocate for the implementation of glucocorticoid in the early phase after surgery for enhanced organ protection.

Keywords: Aortic dissection; Glucocorticoids; Inflammation; Organ dysfunction.