Cumulative Corticosteroid Exposure and Infection Risk After Complex Pediatric Cardiac Surgery
Abstract
Background Children undergoing cardiac surgery may receive corticosteroids preoperatively to temper cardiopulmonary bypass-related inflammation, postoperatively for hemodynamic instability, and periextubation to reduce airway edema. Recent data have associated preoperative corticosteroids with infection. We aimed to determine if there is a relationship between cumulative corticosteroid exposure and infection. Methods A retrospective review of children who underwent cardiac surgery at our institution from January 2009 to July 2010 was performed. To limit study heterogeneity, patients who were 5 years or younger with basic Aristotle score of 7 or higher and intensive care unit stay of 7 days or more were included. Infections during the first 30 postoperative days were recorded, defined as clinically relevant positive blood, urine, respiratory, or wound cultures, or culture-negative sepsis treated with 7 or more days of antimicrobial therapy. Multivariate logistic regression analysis was performed to determine independent risk factors for infection. Results Seventy-six patients were reviewed. All patients received intraoperative methylprednisolone, 48% received postoperative hydrocortisone, and 86% received periextubation dexamethasone. Twenty-six patients (36%) had 58 infections. On univariate analysis, patients with infection had greater median comprehensive Aristotle score (14.5 [intraquartile range (IQR): 12.5 to 16] versus 11.5 [IQR: 10 to 13.1], p = 0.001), maximum vasoact…
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Administration of high-dose glucocorticoids may be associated with increased morbidity.
“In addition, the administration of high dose glucocorticoids may be associated with increased morbidity [23-25].”
From Management of the Low Cardiac Output Syndrome Following Surgery for Congenital Heart Disease (2016) · cites this paper as [24]
Cumulative steroid exposure (7 vs. 4 days, p<0.001) has been shown to be independently associated with occurrence of infection in postoperative cardiac patients.
“Most recently, cumulative steroid exposure (7 vs. 4 days, p<0.001) has been shown to be independently associated with occurrence of infection in postoperative cardiac patients [24].”
From Management of the Low Cardiac Output Syndrome Following Surgery for Congenital Heart Disease (2016) · cites this paper as [24]
Cites
Gaies, M. G., Gurney, J. G., Yen, A. H., Napoli, M. L., Gajarski, R. J., Ohye, R. G., Charpie, J. R., & Hirsch, J. C. (2010) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0b013e3181b806fc · Cited by 1,325 · cited 1× · see citing works
“Maximum vasoactive inotrope score during the first 48 postoperative hours has also been shown to be a significant predictor of outcome after pediatric cardiac surgery, more so than other measures of postoperative disease acuity such as Pediatric Risk of Mortality (PRISM) III score and the presence of low cardiac outpu…”
BackgroundKeh, D., Boehnke, T., Weber-Cartens, S., Schulz, C., Ahlers, O., Bercker, S., Volk, H.-D., Doecke, W.-D., Falke, K. J., & Gerlach, H. (2003) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200205-446oc · Cited by 600 · see citing works
Negative regulation of nuclear factor-kappaB activation and function by glucocorticoids
Almawi, W., & Melemedjian, O. (2002) · Journal of Molecular Endocrinology · doi:10.1677/jme.0.0280069 · Cited by 242 · see citing works
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Management of the Low Cardiac Output Syndrome Following Surgery for Congenital Heart Disease
K. Chandler, H., & Kirsch, R. (2016) · Current Cardiology Reviews · doi:10.2174/1573403x12666151119164647 · Cited by 74 · see citing works
“001) has been shown to be independently associated with occurrence of infection in postoperative cardiac patients [24].”
Background
- Authors
- Mastropietro, C. W., Barrett, R., Davalos, M. C., Zidan, M., Valentine, K. M., Delius, R. E., & Walters, H. L.
- Affiliations
- Wayne State University (US)
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2013-06
- Volume
- 95
- Issue
- 6
- Pages
- 2133-2139
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2069960870
- Cited by
- 42
- References
- 3
- Citations by year
- 2025: 1 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 3 · 2019: 1 · 2018: 6 · 2017: 6 · 2016: 6 · 2015: 5 · 2014: 5 · 2013: 3
- FWCI
- 4.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- corticosteroid exposure, postoperative infection, pediatric cardiac surgery, cardiopulmonary bypass, methylprednisolone, cortisol, dexamethasone, sternal closure, vasoactive inotrope score, infection risk factors, sepsis, children under five, intensive care
- MeSH terms
- Academic Medical Centers, Adrenal Cortex Hormones, Bacterial Infections, Cardiopulmonary Bypass, Child, Preschool, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Infusions, Intravenous, Intraoperative Care, Length of Stay, Male, Postoperative Complications, Preoperative Care, Retrospective Studies, Cohort Studies, Incidence, Survival Rate, Multivariate Analysis, Confidence Intervals, Logistic Models, Odds Ratio, Hospital Mortality, Risk Assessment
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