Volume 36, Issue 4 (12-2025)
Studies in Medical Sciences 2025, 36(4): 50-56 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Mahoori A, Hassani E, Salehi S, Hajizadeh T, Khosravi H. The Effect of High and Low Dose Methylprednisolone on Systemic Inflammatory Response to Cardiopulmonary Bypass and Clinical Outcome in Coronary Artery Bypass Graft. Studies in Medical Sciences 2025; 36 (4) :50-56
URL: http://umj.umsu.ac.ir/article-1-6547-en.html
URL: http://umj.umsu.ac.ir/article-1-6547-en.html
Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran , hossein1356khosravi@gmail.com
Abstract: (12 Views)
Background: Cardiopulmonary bypass during coronary artery bypass grafting is associated with activation of systemic inflammatory pathways that may contribute to postoperative complications. Corticosteroids have been used to attenuate cardiopulmonary bypass -induced inflammatory responses; however, the optimal dosing strategy for methylprednisolone remains controversial. This study aimed to compare the effects of high-dose versus low-dose methylprednisolone on systemic inflammatory response and postoperative clinical outcomes in patients undergoing elective coronary artery bypass grafting with cardiopulmonary bypass.
Methods: In this double-masked randomized trial, 40 adult patients undergoing elective coronary artery bypass grafting with cardiopulmonary bypass were assigned to two equal groups. All patients received methylprednisolone at 30 mg/kg in the cardiopulmonary bypass priming solution before initiation of cardiopulmonary bypass. The high-dose group additionally received intravenous methylprednisolone 30 mg/kg after cardiopulmonary bypass separation, while the low-dose group received placebo. Serum tumor necrosis factor-alpha, C-reactive protein, polymorphonuclear leukocyte count, creatine kinase-MB, and blood glucose were measured preoperatively and two hours postoperatively. Clinical outcomes evaluated included mechanical ventilation duration, inotropic support requirement, and ICU stay.
Results: Baseline demographic and intraoperative variables were comparable. Postoperative tumor necrosis factor-alpha, C-reactive protein, creatine kinase-MB, and blood glucose increased in both groups without significant intergroup differences (p > 0.05). However, postoperative polymorphonuclear leukocyte counts were significantly lower in the high-dose group compared with the low-dose group (8447.35 ± 2932.47 vs. 11398.90 ± 4730.71; P=0.02). No significant differences were observed in mechanical ventilation duration (6.58 ± 2.60 vs. 7.85 ± 4.12 hours; p = 0.25), ICU stay (2.70 ± 0.73 vs. 2.92 ± 0.59 days; p = 0.29), or postoperative inotropic support requirements.
Conclusion: High-dose methylprednisolone during coronary artery bypass grafting with cardiopulmonary bypass significantly reduced postoperative polymorphonuclear leukocyte counts, suggesting partial inflammatory response attenuation. However, no significant improvement was observed in other inflammatory markers or short-term clinical outcomes compared with the low-dose regimen. Routine high-dose methylprednisolone use for coronary artery bypass grafting patients undergoing cardiopulmonary bypass may therefore not provide substantial additional clinical benefit.
Methods: In this double-masked randomized trial, 40 adult patients undergoing elective coronary artery bypass grafting with cardiopulmonary bypass were assigned to two equal groups. All patients received methylprednisolone at 30 mg/kg in the cardiopulmonary bypass priming solution before initiation of cardiopulmonary bypass. The high-dose group additionally received intravenous methylprednisolone 30 mg/kg after cardiopulmonary bypass separation, while the low-dose group received placebo. Serum tumor necrosis factor-alpha, C-reactive protein, polymorphonuclear leukocyte count, creatine kinase-MB, and blood glucose were measured preoperatively and two hours postoperatively. Clinical outcomes evaluated included mechanical ventilation duration, inotropic support requirement, and ICU stay.
Results: Baseline demographic and intraoperative variables were comparable. Postoperative tumor necrosis factor-alpha, C-reactive protein, creatine kinase-MB, and blood glucose increased in both groups without significant intergroup differences (p > 0.05). However, postoperative polymorphonuclear leukocyte counts were significantly lower in the high-dose group compared with the low-dose group (8447.35 ± 2932.47 vs. 11398.90 ± 4730.71; P=0.02). No significant differences were observed in mechanical ventilation duration (6.58 ± 2.60 vs. 7.85 ± 4.12 hours; p = 0.25), ICU stay (2.70 ± 0.73 vs. 2.92 ± 0.59 days; p = 0.29), or postoperative inotropic support requirements.
Conclusion: High-dose methylprednisolone during coronary artery bypass grafting with cardiopulmonary bypass significantly reduced postoperative polymorphonuclear leukocyte counts, suggesting partial inflammatory response attenuation. However, no significant improvement was observed in other inflammatory markers or short-term clinical outcomes compared with the low-dose regimen. Routine high-dose methylprednisolone use for coronary artery bypass grafting patients undergoing cardiopulmonary bypass may therefore not provide substantial additional clinical benefit.
Keywords: Cardiopulmonary bypass, Coronary artery bypass, Methylprednisolone, Systemic inflammatory response syndrome, Tumor necrosis factor-alpha
Type of Study: Research |
Subject:
عروق(جراحی)
References
1. Banerjee D, Feng J, Sellke FW. Strategies to attenuate maladaptive inflammatory response associated with cardiopulmonary bypass. Front Surg. 2024;11:1224068. [DOI:10.3389/fsurg.2024.1224068] [PMID] [PMCID]
2. Ferreira LO, Vasconcelos VW, Lima JdS, Vieira Neto JR, da Costa GE, Esteves JdC, et al. Biochemical changes in cardiopulmonary bypass in cardiac surgery: new insights. J Pers Med. 2023;13(10):1506. [DOI:10.3390/jpm13101506] [PMID] [PMCID]
3. Yan Y, Kamenshchikov N, Zheng Z, Lei C. Inhaled nitric oxide and postoperative outcomes in cardiac surgery with cardiopulmonary bypass: A systematic review and meta-analysis. Nitric Oxide. 2024;146:64-74. [DOI:10.1016/j.niox.2024.03.004] [PMID]
4. Paparella D, Yau T, Young E. Cardiopulmonary bypass-induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg. 2002;21(2):232-44. [DOI:10.1016/S1010-7940(01)01099-5] [PMID]
5. Steinberg JB, Kapelanski DP, Olson JD, Weiler JM. Cytokine and complement levels in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1993;106(6):1008-16. [DOI:10.1016/S0022-5223(19)33971-6] [PMID]
6. M Dieleman J. Corticosteroids for the inflammatory response to cardiopulmonary bypass: an update. Curr Pharm Des. 2013;19(22):3979-91. [DOI:10.2174/1381612811319220006] [PMID]
7. Group CH, Abbasciano RG, Olivieri GM, Chubsey R, Gatta F, Tyson N, et al. Prophylactic corticosteroids for cardiopulmonary bypass in adult cardiac surgery. Cochrane Database Syst Rev. 1996;2024(3). [DOI:10.1002/14651858.CD005566.pub4] [PMID] [PMCID]
8. Losiggio R, Lomivorotov V, Ursoleo JDA, Kotani Y, Monaco F, Milojevic M, et al. The effects of corticosteroids on survival in pediatric and nonelderly adult patients undergoing cardiac surgery: a meta-analysis of randomized studies. J Cardiothorac Vasc Anesth. 2024;38(11):2783-91. [DOI:10.1053/j.jvca.2024.07.001] [PMID]
9. Chen L, Xiang F, Hu Y. Corticosteroids in patients undergoing cardiac surgery: A meta-analysis of 12,559 patients. Perfusion. 2023;38(4):853-9. [DOI:10.1177/02676591221106324] [PMID]
10. Varan B, Tokel K, Mercan S, Dönmez A, Aslamaci S. Systemic inflammatory response related to cardiopulmonary bypass and its modification by methyl prednisolone: high dose versus low dose. Pediatr Cardiol. 2002;23(4):437-41. [DOI:10.1007/s00246-002-0118-3] [PMID]
11. Wahba A, Kunst G, De Somer F, Agerup Kildahl H, Milne B, Kjellberg G, et al. 2024 EACTS/EACTAIC/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery. Interdiscip Cardiovasc Thorac Surg. 2025;40(2):ivaf002. [DOI:10.1093/icvts/ivaf002] [PMID] [PMCID]
12. Squiccimarro E, Stasi A, Lorusso R, Paparella D. Narrative review of the systemic inflammatory reaction to cardiac surgery and cardiopulmonary bypass. Artif Organs. 2022;46(4):568-77. [DOI:10.1111/aor.14171] [PMID] [PMCID]
13. Warltier DC, Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology. 2002;97(1):215-52. [DOI:10.1097/00000542-200207000-00030] [PMID]
14. Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol. 2017;13(11):697-711. [DOI:10.1038/nrneph.2017.119] [PMID]
15. Ortega-Loubon C, Fernández-Molina M, Carrascal-Hinojal Y, Fulquet-Carreras E. Cardiac surgery-associated acute kidney injury. Ann Card Anaesth. 2016;19(4):687-98. [DOI:10.4103/0971-9784.191578] [PMID] [PMCID]
16. Whitlock RP, Devereaux P, Teoh KH, Lamy A, Vincent J, Pogue J, et al. Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial. The Lancet. 2015;386(10000):1243-53. [DOI:10.1016/S0140-6736(15)00273-1] [PMID]
17. Dieleman JM, Nierich AP, Rosseel PM, Van Der Maaten JM, Hofland J, Diephuis JC, et al. Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial. JAMA. 2012;308(17):1761-7. [DOI:10.1001/jama.2012.14144] [PMID]
18. Chubsey R, Tyson N, Zakkar M. Prophylactic corticosteroids for cardiopulmonary bypass in adult cardiac surgery. 2024. [DOI:10.1002/14651858.CD005566.pub4] [PMID] [PMCID]
19. Herbst RA, Telford OT, Hunting J, Bullock WM, Manning E, Hong BD, et al. The effects of perioperative dexamethasone on glycemic control and postoperative outcomes. Endocr Pract. 2020;26(2):218-25. [DOI:10.4158/EP-2019-0252] [PMID]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
