Studies in Medical Sciences

en The Effect of High and Low Dose Methylprednisolone on Systemic Inflammatory Response to Cardiopulmonary Bypass and Clinical Outcome in Coronary Artery Bypass Graft عروق(جراحی) عروق(جراحی) پژوهشي(توصیفی- تحلیلی) Research   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. Cardiopulmonary bypass, Coronary artery bypass, Methylprednisolone, Systemic inflammatory response syndrome, Tumor necrosis factor-alpha 50 56 http://umj.umsu.ac.ir/browse.php?a_code=A-10-5982-1&slc_lang=en&sid=1 ALireza Mahoori ar_mahoori@yahoo.com 3700319475328460038760 3700319475328460038760 No Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran Ebrahim Hassani ehassani87@gmail.com 3700319475328460038761 3700319475328460038761 No Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran Shahyad Salehi m.ehsasatvatan@yahoo.com 3700319475328460038762 3700319475328460038762 No Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran Tahereh Hajizadeh biotech869@yahoo.com 3700319475328460038763 3700319475328460038763 No Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran Hossein Khosravi hossein1356khosravi@gmail.com 3700319475328460038764 0009-0007-7410-2690 Yes Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran