cc2151 CCJ Meeting abstract <p>Influence of stress doses of hydrocortisone on levels of cytokines and nuclear transcription factor kappa B in patients after cardiac surgery</p> Weis F Briegel J Goetz AE Reuter D Fraunberger P Walli A Kilger E Erich.Kilger@ana.med.uni-muenchen.de

Department of Anaesthesiology, Klinikum Groβhadern, Ludwig Maximillian University Munich, Germany

Department of Clinical Chemistry, Klinikum Groβhadern, Ludwig Maximillian University Munich, Germany

 Critical Care <p>4th International Symposium on the Pathophysiology of Cardiopulmonary Bypass: Endothelial Damage. Abstracts</p> Meeting abstracts <p>4th International Symposium on the Pathophysiology of Cardiopulmonary Bypass: Endothelial Damage. Abstracts</p> Munich, Germany 29 November 2002 1364-8535 2003 7 Suppl 1 5 10.1186/cc2151 18 2 2003

Objectives

Severe systemic inflammation (SIRS) is a serious complication in patients after cardiac surgery. Hydrocortisone has been successfully used to treat this complication (Kilger et al., Crit Care Med, in press), potentially by lowering levels of proinflammatory cytokines. The purpose of this prospective, randomized, double-blind, placebo-controlled trial was to evaluate the influence of stress doses of hydrocortisone on levels of cytokines and nuclear factor-κB (NF-κB) in a group of high-risk patients after cardiac surgery.

Methods

Twenty-two cardiac surgical patients were randomly assigned to receive stress doses of hydrocortisone or placebo from the time point of induction of anesthesia until discharge from the intensive care unit. Levels of NF-κB, IL-6, tumor necrosis factor (TNF)-α and IL-10 were measured preoperatively, and 4 and 24 hours after the operation. Activation of NF-κB was assayed in nuclear extracts from monocytes.

Results

Patients demographic data were similar in both groups.

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Placebo (n = 11)

Hydrocortisone (n = 11)

P

NF-kκB (1 hour; %)

66 (27/125)

75 (50/98)

NS

NF-kκB (24 hours; %)

86 (61/116)

59 (34/105)

NS

TNF-α (4 hours)

45 (31/66)

31 (28/40)

NS

TNF-α (24 hours)

41 (17/45)

27 (16/40)

NS

IL-6 (pg/ml; 4 hours)

438 (396/931)

178 (93/375)

<0.01

IL-6 (pg/ml; 24 hours)

281(245/454)

139 (104/231)

<0.05

IL-10 (pg/ml; 4 hours)

16 (9/42)

137 (79/215)

<0.001

IL-10 (pg/ml; 24 hours)

3.5 (2/10)

3.5 (1/12)

NS

Conclusions

In our study, hydrocortisone reduced the postoperative serum levels of IL-6 and increased the levels of IL-10. The levels of TNF-α and NF-κB remained unaffected. Increased levels of IL-6 may be independent of TNF-α. Further studies are needed to clarify this point.