Longitudinal assessment of preoperative dexamethasone administration on cognitive function after cardiac surgery: a 4-year follow‐up of a randomized controlled trial

Abstract

Background The pathogenesis of postoperative cognitive decline (POCD) is still poorly understood; however, the inflammatory response to surgical procedures seems likely to be involved. In addition, our recent randomized controlled trial showed that perioperative corticosteroid treatment may ameliorate early POCD after cardiac surgery. To assess the long-term effect of dexamethasone administration on cognitive function, we conducted a 4-year follow-up. Methods The patients were randomized to receive a single intravenous bolus of 0.1 mg kg− 1 dexamethasone or placebo 10 h before elective cardiac surgery. The endpoint in both groups was POCD incidence on the 6th day and four years postoperatively. Results Of the 161 patients analyzed previously, the current follow-up included 116 patients. Compared to the 62 patients in the placebo group, the 54 patients in the dexamethasone group showed a lower incidence of POCD on the 6th day (relative risk (RR), 0.510; 95 % confidence interval (CI), 0.241 to 1.079; p = 0.067, time interval also analyzed previously) and four years (RR, 0.459; 95 % CI, 0.192 to 1.100; p = 0.068) after cardiac surgery. The change in cognitive status between the two postoperative measurements was not significant (p = 0.010) among the patients in the dexamethasone group, in contrast to patients in the placebo group (p = 0.673). Conclusions Although statistical significance was not reached in the current study, the prophylactic administration of dexamethasone seems to be useful to prevent POCD development following cardiac surgery. However, further large multicenter research is needed to confirm these directions. Trial registration ClinicalTrials.gov identifier: NCT02767713 (10/05/2016).

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“…While preoperative administration of dexamethasone showed some benefit in reducing POD at the 6 day and 4-year mark, it did not reach statistical significance. 6 In another review covering over 8000 patients it was determined that while administration of glucocorticoids did not reduce POD, they did reduce time on the ventilator, as well as time in the ICU--two factors that we know greatly contribute to the development of POD. 7 The meta-analysis did not show any significant impact on blood sugar, wound healing or gastric injury in the trial group compared to the control group--possibly indicating that the administration of steroids may provide some benefit without a significant detrimental effect.…”

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“…The use of drug during anesthesia process also significantly affects the development of POCD. Glumac et al also found that the prophylactic administration of dexamethasone seems to be useful to prevent POCD development following cardiac surgery [ 30 ]. Insomnia will lead to increased aldosterone secretion in the body and increased blood pressure [ 23 , 24 , 31 ].…”

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“…That was also the first study to confirm that the systemic inflammatory response is inhibited by dexamethasone based on inflammatory markers ( p < 0.001). In a follow-up from their 2017 study, Glumac et al ( 83 ) observed that dexamethasone reduced the incidence of cognitive impairment over 4 years. However, this finding narrowly failed to reach significance (RR: 0.459; 95% CI: 0.192–1.100; p = 0.068) ( 83 ).…”

“…In a follow-up from their 2017 study, Glumac et al ( 83 ) observed that dexamethasone reduced the incidence of cognitive impairment over 4 years. However, this finding narrowly failed to reach significance (RR: 0.459; 95% CI: 0.192–1.100; p = 0.068) ( 83 ). This study was the first long-term study to assess the effect of dexamethasone on cognitive outcomes following cardiac surgery.…”

“…Conversely, follow up after 5 years postoperatively may also not reflect the effects of dexamethasone, as the results may be confounded by age related cognitive decline, the development or progression of new cardiovascular or cerebrovascular disease, and the development of dementia. Glumac et al ( 83 ) also investigated whether cognitive impairment at POD6 influenced the development of cognitive impairment at 4 years. Thirteen patients who did not have POCD at POD6, had POCD detected at 4 years post-operatively.…”