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

Published online by Cambridge University Press:  28 April 2015

Muhammad M. Amanullah ,
Mohammad Hamid ,
Hashim M. Hanif ,
Marium Muzaffar ,
Maria T. Siddiqui ,
Fatima Adhi ,
Khabir Ahmad ,
Shahjahan Khan  and
Zahra Hasan
Muhammad M. Amanullah*
Affiliation:
Department of Surgery, AKUH, Karachi, Pakistan
Mohammad Hamid
Affiliation:
Department of Cardiac Anaesthesia, AKUH, Karachi, Pakistan
Hashim M. Hanif
Affiliation:
Department of Surgery, AKUH, Karachi, Pakistan
Marium Muzaffar
Affiliation:
Department of Surgery, AKUH, Karachi, Pakistan
Maria T. Siddiqui
Affiliation:
Department of Surgery, AKUH, Karachi, Pakistan
Fatima Adhi
Affiliation:
Department of Surgery, AKUH, Karachi, Pakistan
Khabir Ahmad
Affiliation:
Department of Surgery, AKUH, Karachi, Pakistan
Shahjahan Khan
Affiliation:
Medical College, Agha Khan University, AKUH, Karachi, Pakistan
Zahra Hasan
Affiliation:
Department of Pathology and Microbiology, AKUH, Karachi, Pakistan
*
Correspondence to: M. M. Amanullah, Congenital Cardiac Surgery, Department of Surgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi 74800, Pakistan. Tel: +922134930051, ext. 4708; Fax: +922134932095; E-mail: muneer.amanullah@aku.edu
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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 bypasscongenital heart diseasesteroidsinflammatory markers
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 3 , March 2016 , pp. 506 - 515
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Copyright
© Cambridge University Press 2015 

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