Document Detail


Stress doses of hydrocortisone in high-risk patients undergoing cardiac surgery: effects on interleukin-6 to interleukin-10 ratio and early outcome.
MedLine Citation:
PMID:  19325469     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Severe systemic inflammation (systemic inflammatory response syndrome) associated with cardiac surgery often leads to a worse short-term and long-term outcome. Stress doses of hydrocortisone have been successfully used to improve outcome of CS. The interleukin (IL)-6 to IL-10 ratio is associated with outcome after trauma and major surgery. OBJECTIVE: To evaluate immunologic effects (especially IL-6 to IL-10 ratio) of stress doses of hydrocortisone in a high-risk group of patients after cardiac surgery with cardiopulmonary bypass. DESIGN: Prospective, randomized, double-blinded, placebo-controlled trial. SETTING: Cardiovascular intensive care unit of a university hospital. PATIENTS: High-risk patients (n = 36) undergoing CS. INTERVENTION: Stress doses of hydrocortisone or placebo. MAIN OUTCOME MEASURES: IL-6 to IL-10 ratio and other markers of systemic inflammation at predefined time points; short-term clinical outcome. RESULTS: The two study groups did not differ with regard to demographic data. The patients from the hydrocortisone group (n = 19) had significantly lower levels of IL-6 and higher levels of IL-10, resulting in an attenuated change in IL-6/IL-10 ratio (28.7 [6.4/128.7] vs. 292.8 [6.5/534.6] 4 hours after cardiopulmonary bypass; p < 0.001). Patients in the hydrocortisone group had a shorter duration of catecholamine support (1 [1/2] vs. 4 [2/4.5] days; p = 0.02), a shorter length of stay in the intensive care unit (2 [2/3] vs. 6 [4/8] days; p = 0.001), and a lower incidence of postoperative atrial fibrillation (26% vs. 59%; p = 0.04). CONCLUSIONS: Stress doses of hydrocortisone attenuate the evolution of IL-6/IL-10 ratio in patients with systemic inflammatory response syndrome after CS, which seems to be associated with an improved outcome. The immunologic effects of hydrocortisone may thus be both, inhibitory (IL-6) and permissive (IL-10), regarding the immune response.
Authors:
Florian Weis; Andres Beiras-Fernandez; Gustav Schelling; Josef Briegel; Philip Lang; Daniela Hauer; Simone Kreth; Ines Kaufmann; Peter Lamm; Erich Kilger
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Critical care medicine     Volume:  37     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-20     Completed Date:  2009-05-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1685-90     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, University of Munich, Klinikum Grosshadern, Munich, Germany. florian.weis@med.uni-muenchen.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers / blood
Cardiac Care Facilities
Cardiac Surgical Procedures / methods*,  mortality
Dose-Response Relationship, Drug
Double-Blind Method
Drug Administration Schedule
Female
Hospital Mortality / trends*
Humans
Hydrocortisone / administration & dosage*
Injections, Intravenous
Intensive Care Units
Interleukin-10 / blood
Interleukin-6 / blood
Male
Middle Aged
Postoperative Care / methods
Preoperative Care
Prospective Studies
Reference Values
Risk Assessment
Survival Analysis
Systemic Inflammatory Response Syndrome / mortality,  prevention & control*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Interleukin-6; 130068-27-8/Interleukin-10; 50-23-7/Hydrocortisone
Comments/Corrections
Comment In:
Crit Care Med. 2009 May;37(5):1815   [PMID:  19373058 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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