Effect of high-dose dexamethasone on perioperative lactate levels and glucose control: a randomized controlled trial

Abstract

IntroductionBlood lactate levels are increasingly used to monitor patients. Steroids are frequently administered to critically ill patients. However, the effect of steroids on lactate levels has not been adequately investigated. We studied the effect of a single intraoperative high dose of dexamethasone on lactate and glucose levels in patients undergoing cardiac surgery.MethodsThe Dexamethasone for Cardiac Surgery (DECS) trial was a multicenter randomized trial on the effect of dexamethasone 1 mg/kg versus placebo on clinical outcomes after cardiac surgery in adults. Here we report a pre-planned secondary analysis of data from DECS trial participants included at the University Medical Center Groningen. The use of a computer-assisted glucose regulation protocol—Glucose Regulation for Intensive care Patients (GRIP)—was part of routine postoperative care. GRIP aimed at glucose levels of 4 to 8 mmol/L. Primary outcome parameters were area under the lactate and glucose curves over the first 15 hours of ICU stay (AUC15). ICU length of stay and mortality were observed as well.ResultsThe primary outcome could be determined in 497 patients of the 500 included patients. During the first 15 hours of ICU stay, lactate and glucose levels were significantly higher in the dexamethasone group than in the placebo group: lactate AUC15 25.8 (13.1) versus 19.9 (11.2) mmol/L × hour, P <0.001 and glucose AUC15 126.5 (13.0) versus 114.4 (13.9) mmol/L × hour, P <0.001. In this period, patients in the dexamethasone group required twice as much insulin compared with patients who had received placebo. Multivariate and cross-correlation analyses suggest that the effect of dexamethasone on lactate levels is related to preceding increased glucose levels. Patients in the placebo group were more likely to stay in the ICU for more than 24 hours (39.2%) compared with patients in the dexamethasone group (25.0%, P = 0.001), and 30-day mortality rates were 1.6% and 2.4%, respectively (P = 0.759).ConclusionsIntraoperative high-dose dexamethasone increased postoperative lactate and glucose levels in the first 15 hours of ICU stay. Still, patients in the dexamethasone group had a shorter ICU length of stay and similar mortality compared with controls.Trial registrationClinicalTrials.gov NCT00293592. Registered 16 February 2006.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0736-9) contains supplementary material, which is available to authorized users.

Effect of Dexamethasone on Resting Blood Lactate Concentrations in Horses

“…These results were similar to an earlier study, also showing an increase in blood lactate concentrations in healthy dogs after administration of methylprednisolone . This phenomenon also is observed in human medicine, where cardiac surgery patients receiving a single perioperative high dose of dexamethasone had increased blood lactate (2.1 mmol/L versus 0.7 mmol/L) and blood glucose concentrations (10.0 mmol/L versus 8.0 mmol/L) after surgery compared to the placebo group . Similarly, an increase in blood lactate concentrations also was observed in humans with Cushing's disease or after corticosteroid administration …”

“…Dexamethasone is a corticosteroid often used in equine practice to treat a variety of diseases such as recurrent airway obstruction, inflammatory airway disease, or hemolytic anemia, with suggested dosages ranging from 0.05 to 0.1 mg/kg q24h . A previous study in dogs showed that administration of prednisone caused a statistically significant increase in lactate concentrations, a phenomenon also reported in humans . The mechanism behind this effect is not fully understood, but may be related to the effect of corticosteroids on carbohydrate metabolism, whereby increased rates of glucose production and utilization lead to increased production of pyruvate and lactate …”

Chronic glucocorticoids exposure enhances neurodegeneration in the frontal cortex and hippocampus via NLRP-1 inflammasome activation in male mice

“…The doses of DEX from 0.035 to 1 mg/kg were widely prescribed in clinic for treating many diseases (Dieleman et al, 2011;Din et al, 2015;Ottens et al, 2015), while the doses from 0.5 to 80 mg/kg, especially 5 mg/kg, were widely used in animals to study the neurodegenerative diseases (Danilczuk et al, 2005(Danilczuk et al, , 2006Green et al, 2006). Our previous studies showed that chronic stress (8 weeks) and DEX (5 mg/kg) treatment for 21 days induced learning and memory impairment and hippocampal neurodegeneration (Li et al, 2010;Wang et al, 2014).…”

Relationship Between Lactate Levels And Complications In Coronary Artery Bypass Grafting Surgery

“…Bazı gözlemsel yapılan çalışmalarda, hematokrit değerindeki düşüklük ile laktat seviyesinde yükselme olduğu gösterilmiştir [9,20,21] . Fakat randomize yapı-lan bir araştırmada, hematokrit değeri %20 ile %25 olan hasta grupları karşılaştırılmış, intraoperatif ve postoperatif dönemde laktat düzeyinde artma ile bir ilişkisi olmadığı sonucuna varılmıştır [22] .…”

“…Oksijen sunumu kritik bir değerin altına düştüğünde oksijen tüketimi sunuma bağımlı hâle gelmekte ve laktik asidoz oluşmaktadır [5,6] . Kardiyopulmoner baypas sırasında inflamatuar yanıt olarak salınan bazı sitokinler ve diyabetojenik hormonlar laktat yüksekliğine, insülin rezistansına ve kan şekerinde artışa neden olmaktadır [7][8][9] . Yapı-lan çalışmalarda da ayrıca uzamış kardiyopulmoner baypasın yüksek laktat seviyeleri için bir risk faktörü olduğu belirtilmektedir [10][11][12] .…”