Effect of steroids on inflammatory markers and clinical parameters in congenital open heart surgery: A randomised controlled trial

Muhammad M. Amanullah, Mohammad Hamid, Hashim M. Hanif, Marium Muzaffar, Maria T. Siddiqui, Fatima Adhi, Khabir Ahmad, Shahjahan Khan, Zahra Hasan

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21 Citations (Scopus)


Background Cardiopulmonary bypass is associated with systemic inflammatory response. Steroids suppress this response, although the therapeutic evidence remains controversial. We hypothesised that intravenous steroids in children undergoing open-heart surgery would decrease inflammation leading to better early post-operative outcomes. We conducted a randomised controlled trial to evaluate the trends in the levels of immunomodulators and their effects on clinical parameters. Objective To assess the effects of intravenous steroids on early post-operative inflammatory markers and clinical parameters in children undergoing open-heart surgery. Materials and methods A randomised controlled trial involving 152 patients, from one month up to 18 years of age, who underwent open-heart surgery for congenital heart disease from April 2010-2012 was carried out. Patients were randomised and administered either three scheduled intravenous pulse doses of dexamethasone (1 mg/kg) or placebo. Blood samples were drawn at four time intervals and serum levels of inflammatory cytokines - Interleukin-6, 8, 10, 18, and tumour necrosis factor-alpha - were measured. Clinical parameters were also assessed. Results Blood cytokine levels were compared between the dexamethasone (n=65) and placebo (n=64) groups. Interleukin-6 levels were lower at 6 and 24 hours post-operatively (p<0.001), and Interleukin-10 levels were higher 6 hours post-operatively (p<0.001) in the steroid group. Interleukin-8, 18, and tumour necrosis factor-alpha levels did not differ between the groups at any time intervals. The clinical parameters were similar in both the groups. Conclusion Dexamethasone caused quantitative suppression of Interleukin-6 and increased Interleukin-10 activation, contributing to reduced immunopathology, but it did not translate into clinical benefit in the short term.

Original languageEnglish
Pages (from-to)506-515
Number of pages10
JournalCardiology in the Young
Issue number3
Publication statusPublished - 1 Mar 2016


  • Cardiopulmonary bypass
  • congenital heart disease
  • inflammatory markers
  • steroids


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