| Stress doses of hydrocortisone in high-risk patients undergoing cardiac surgery: effects on interleukin-6 to interleukin-10 ratio and early outcome. | |
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MedLine Citation:
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PMID: 19325469 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Critical care medicine Volume: 37 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2009 May |
Date Detail:
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Created Date: 2009-04-20 Completed Date: 2009-05-05 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1685-90 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology, University of Munich, Klinikum Grosshadern, Munich, Germany. florian.weis@med.uni-muenchen.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Biological Markers; 0/Interleukin-6; 130068-27-8/Interleukin-10; 50-23-7/Hydrocortisone |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2009 May;37(5):1815
[PMID:
19373058
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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