Influence of aminosteroid and glucocorticoid treatment on inflammation and immune function during cardiopulmonary bypass

Volk, Thomas; Schmutzler, M.; Engelhardt, Lars; Döcke, W D; Volk, Hans‐Dieter; Konertz, Wolfgang; Kox, Wolfgang J.

doi:10.1097/00003246-200111000-00015

Cited by 45 publications

(28 citation statements)

References 19 publications

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“…Third, medication effects on circulating CRP and other inflammatory markers should also be considered. Systemic corticosteroids, for instance, may decrease CRP levels 32 while slightly increasing circulating levels of leukocytes and platelets. 33 Exclusion of individuals who were taking oral corticosteroids made no difference to the overall findings, which suggests that this medication was not an important confounder in the analysis.…”

Section: Discussionmentioning

confidence: 99%

Why Are Patients With Chronic Obstructive Pulmonary Disease at Increased Risk of Cardiovascular Diseases?

2003

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Background-Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease 2-to 3-fold.The factors responsible for this association remain largely unknown. Methods and Results-We analyzed data from participants, Ն50 years of age, of the Third National Health and Nutrition Examination Survey (nϭ6629) to determine whether C-reactive protein (CRP) and other systemic inflammatory markers are present in participants with chronic airflow obstruction and are associated with cardiac injury. Participants with severe airflow obstruction had circulating leukocyte, platelet, and fibrinogen levels that were 460/L (95% confidence interval [CI], 30 to 890/L), 39 510/L (95% CI, 21 730 to 57 290/L), and 41.63 mg/dL (95% CI, 19.87 to 63.39 mg/dL) higher, respectively, than in those without airflow obstruction. They were also 2.18 times (95% CI, 1.46 to 3.27) more likely to have an elevated circulating CRP level. Moderate airflow obstruction was associated with smaller but still significant increases in these levels. Moderate and severe airflow obstruction was associated with increased occurrence of ischemic changes on electrocardiograms of participants. In the presence of both highly elevated CRP and moderate or severe airflow obstruction, the Cardiac Infarction Injury Score was 2.68 and 5.88 U higher, respectively, than in those without airflow obstruction and with low CRP, which suggests an additive effect of CRP and COPD on the risk of cardiac injury. Conclusion-Low-grade systemic inflammation was present in participants with moderate to severe airflow obstruction and was associated with increased risk of cardiac injury. This may in part explain the high rates of cardiovascular complications in COPD.

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Section: Discussionmentioning

confidence: 99%

Why Are Patients With Chronic Obstructive Pulmonary Disease at Increased Risk of Cardiovascular Diseases?

2003

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“…They suggest that glucocorticoid action may represent another mechanism for the development of innate immune dysfunction. Similarly, Volk et al demonstrated that the administration of methylprednisolone in the setting of cardiopulmonary bypass resulted in an exacerbation of innate immunosuppression over that which was seen with byass alone [54].…”

Section: Mechanisms Of Immunoparalysismentioning

confidence: 99%

Immunoparalysis and Adverse Outcomes from Critical Illness

Frazier

Hall

2008

Pediatric Clinics of North America

131

108

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“…The clinical manifestation of SIRS following CPB is mediated via cell-derived cytokines that target end-organ receptors. After CPB, elevated serum levels of the pro-inflammatory cytokines, tumor necrosis factor (TNF)-a, interleukin (IL)-6 and IL-8, as well as the anti-inflammatory cytokine IL-10 have been found 2,3 . The potent vasodilator nitric oxide (NO) has also been implicated in SIRS pathophysiology.…”

Section: Introductionmentioning

confidence: 99%

Effect of myocardial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypass

et al. 2007

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Effect of myocardial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypassEffect of myocardial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypass ABSTRACT Purpose: To investigate the effects of different conditions used during cardiopulmonary bypass (CPB) surgery on accompanying production of cytokine and nitric oxide (NO). Methods: Patients undergoing CPB for the first time were prospectively enrolled and divided into two groups according to CPB parameters performed: i) normothermia (36.5-37°C) with blood cardioplegia (NB group, n=10) and ii) hypothermia (29-31°C) with crystalloid cardioplegia (HC group, n=10). Plasma samples obtained following intubation (baseline), during (5 and 30 min) and after (4 and 24 h) CPB were assayed for cytokines (ELISA) and NO metabolites (Griess reaction). Results: Peak concentrations of interleukin (IL)-6 and IL-8 were reached at 4 h post CPB in both groups, but in the HC group those levels increased earlier and persisted for longer (24 h) compared to baseline (P < 0.05). IL-10 levels also increased at 4 h compared to baseline, but only significantly so in the HC group. NO metabolites were reduced in HC group at all time points compared to baseline (P < 0.05), while no significant differences were detected in the NB group. Conclusion: The association between increased systemic levels of cytokines and reduced NO production in the HC group suggests that different myocardial protection and/or perfusion temperature used during CPB may contribute to the extent of inflammatory response. Key words: Cardiopulmonary Bypass. Myocardium. Perfusion. Nitric Oxide. Cytokines. RESUMOObjetivo: Investigar a hipótese de que diferentes procedimentos durante o bypass cardiopulmonary (BCP) causa diferentes níveis de citocinas (IL) e óxido nítrico (NO). Métodos: Pacientes submetidas a BCP foram prospectivamente estudadas de acordo com bypass realizado sobre normotermia (36.5-37°C) com cardioplegia sanguínea (NB group, n=10) or hipotermia (29-31°C) com cardioplegia cristalóide (HC group, n=10). Amostras de Plasma foram obtidas após a intubação (linha de base), durante (5, 30 min) e após (4, 24 h) o BCP. Os ensaios foram realizados através de ELISA (IL) e metabólitos do NO (reação de Griess). Resultados: Os picos de concentrações de IL-6 and IL-8 estavam aumentados em 4 h pós BCP em ambos os grupos, mas no grupo HC estes níveis aumentaram precocemente e persistiram aumentadas por 24 h, comparado a linha de base (P<0.05). O nível de IL-10 também teve o pico em 4 h, mas estatisticamente significante somente no grupo HC, comparado a linha de base. Os metabólitos do NO estavam reduzidos no grupo HC, em todo o tempo, comparado a linha de base (P<0.05), enquanto nenhuma diferença estatisticamente significante foi detectada no grupo NB. Conclusão: A associação entre o aumento sistêmico dos níveis de citocina e a redução da produção de NO no grupo HC sugere que o tipo de proteção miocárdica e/ou ...

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Influence of aminosteroid and glucocorticoid treatment on inflammation and immune function during cardiopulmonary bypass

Cited by 45 publications

References 19 publications

Why Are Patients With Chronic Obstructive Pulmonary Disease at Increased Risk of Cardiovascular Diseases?

Why Are Patients With Chronic Obstructive Pulmonary Disease at Increased Risk of Cardiovascular Diseases?

Immunoparalysis and Adverse Outcomes from Critical Illness

Effect of myocardial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypass

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