Benefits and Risks of Corticosteroid Prophylaxis in Adult Cardiac Surgery: A Dose-Response Meta-Analysis
Abstract
BACKGROUND: Cardiopulmonary bypass and cardiac surgery are associated with a significant systemic inflammatory response that may increase postoperative complications. This meta-analysis assessed whether the benefits and risks of corticosteroid use were dose dependent in adult cardiac surgery. METHODS AND RESULTS: Randomized controlled trials of the use of corticosteroid prophylaxis in adult cardiac surgery (>18 years of age) requiring cardiopulmonary bypass were selected from MEDLINE (1966 to August 1, 2008), EMBASE (1988 to August 1, 2008), and the Cochrane controlled trials register without any language restrictions. A total of 3323 patients from 50 randomized controlled trials were identified and subject to meta-analysis. Corticosteroid prophylaxis reduced the risk of atrial fibrillation (25.1% versus 35.1%; number needed to treat, 10; relative risk, 0.74; 95% confidence interval [CI], 0.63 to 0.86; P<0.01) and length of stay in the intensive care unit (weighted mean difference, -0.37 days; 95% CI, -0.21 to -0.52; P<0.01) and hospital (weighted mean difference, -0.66 days; 95% CI, -0.77 to -1.25; P=0.03) compared with placebo. The use of corticosteroid was not associated with an increased risk of all-cause infection (relative risk, 0.93; 95% CI, 0.61 to 1.41; P=0.73), but hyperglycemia requiring insulin infusion after corticosteroid prophylaxis was common (28.2%; relative risk, 1.49; 95% CI, 1.11 to 2.01; P<0.01). No additional benefits were found on all outcomes beyond a total dose of 1000 mg hydrocortisone, and very high doses of corticosteroid were associated with prolonged mechanical ventilation. CONCLUSIONS: Evidence suggests that low-dose corticosteroid is as effective as high-dose corticosteroid in reducing the risk of atrial fibrillation and duration of mechanical ventilation but with fewer potential side effects in adult cardiac surgery.
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This high incidence has been related to inflammatory changes in the atrial myocardium, similar to experimental pericarditis animal models, and may be prevented by anti-inflammatory corticosteroid or colchicine treatment.
“This high incidence has been related to inflammatory changes in the atrial myocardium, 213 not unlike the experimental pericarditis animal models, and it may be prevented by anti-inflammatory corticosteroid or colchicine treatment.214”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [214]
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- Authors
- Ho, K. M., & Tan, J. A.
- Affiliations
- The University of Western Australia (AU)
- ORCID
- Ho, Kwok M.
- Venue
- Circulation
- Published
- 2009-04-14
- Volume
- 119
- Issue
- 14
- Pages
- 1853-1866
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2038504749
- Cited by
- 245
- References
- 59
- Citations by year
- 2026: 3 · 2025: 17 · 2024: 10 · 2023: 7 · 2022: 17 · 2021: 13 · 2020: 14 · 2019: 15 · 2018: 7 · 2017: 19 · 2016: 16 · 2015: 19 · 2014: 17 · 2013: 16 · 2012: 18
- FWCI
- 2.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Murdoch University Research Portal (submittedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Keywords
- corticosteroid prophylaxis, cardiac surgery, cardiopulmonary bypass, cortisol, dose dependence, atrial fibrillation, postoperative complications, systemic inflammatory response, length of hospital stay, infection risk, hyperglycemia, mechanical ventilation, intensive care unit
- MeSH terms
- Adrenal Cortex Hormones, Adult, Atrial Fibrillation, Cardiopulmonary Bypass, Cardiac Surgical Procedures, Humans, Inflammation, Intraoperative Complications, Length of Stay, Postoperative Complications, Reperfusion Injury, Survival Analysis, Randomized Controlled Trials as Topic, Treatment Outcome, Survivors, Risk Assessment, Patient Selection
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