The DOI matches its Crossref record; 58 of the 59 references it cites were found in a registry or an index.
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139
Duval, S., & Tweedie, R. (2000) · Biometrics · doi:10.1111/j.0006-341x.2000.00455.x · Cited by 14,099
Interaction revisited: the difference between two estimates.
Altman, D. G., & Bland, J. M. (2003) · BMJ · doi:10.1136/bmj.326.7382.219 · Cited by 3,203
Activation of the Complement System During and After Cardiopulmonary Bypass Surgery
Bruins, P., Velthuis, H. T., Yazdanbakhsh, A. P., Jansen, P. G. M., van Hardevelt, F. W. J., de Beaumont, E. M. F. H., Wildevuur, C. R. H., Eijsman, L., Trouwborst, A., & Hack, C. E. (1997) · Circulation · doi:10.1161/01.cir.96.10.3542 · Cited by 792
Corticosteroids for the Prevention of Atrial Fibrillation After Cardiac Surgery
Halonen, J., Halonen, P. M., Järvinen, O., Taskinen, P., Auvinen, T., Tarkka, M. R., Hippeläinen, M., Juvonen, T. S., Hartikainen, J. E. K., & Hakala, T. (2007) · JAMA · doi:10.1001/jama.297.14.1562 · Cited by 335
Ishii, Y., Schuessler, R. B., Gaynor, S. L., Yamada, K., Fu, A. S., Boineau, J. P., & Damiano, R. J. (2005) · Circulation · doi:10.1161/circulationaha.104.475194 · Cited by 319
Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass
Jansen, N. J. G., van Oeveren, W., van den Broek, L., Straaten, H. M. O., Stoutenbeek, C. P., Joen, M. C. N., Roozendaal, K. J., Eysman, L., & Wildevuur, C. R. H. (1991) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(20)31421-5 · Cited by 203
Whitlock, R. P., Chan, S., Devereaux, P. J., Sun, J., Rubens, F. D., Thorlund, K., & Teoh, K. (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn333 · Cited by 201
Kilger, E., Weis, F. C., Briegel, J., Frey, L., Goetz, A. E., Reuter, D. A., Nagy, A., Schuetz, A., Lamm, P., Knoll, A. E., et al. (2003) · Critical Care Medicine · doi:10.1097/01.ccm.0000059646.89546.98 · Cited by 187
Weis, F. C., Kilger, E., Roozendaal, B., de Quervain, D. J. ‐., Lamm, P., Schmidt, M., Schmölz, M., Briegel, J., & Schelling, G. (2006) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2005.07.063 · Cited by 172
Flagged first, then by citations
1 of the 59 references couldn’t be matched to a known paper.
Research works printed but not linked: 3
- 10.1161/circ.96.10.3542 · DOI
- Abd El-Hakeem EE, El-Minshawy AM. Influence of dexamethasone on cytokine balance in patients undergoing valve replacement surgery. Eg J Anaesth. 2003; 19: 205–214.
- Abd El-Hakeem EE, Zareh ZE. Effects of dexamethasone on the incidence of shivering and recovery in patients undergoing valve replacement surgery. Egypt J Anaesth. 2003; 19: 361–70.
Cited by
Sorted by citations
Items 201–244 of 244
Analyzing the Data for Steroids in Cardiac Surgery
Crawford, J. H., & Townsley, M. M. (2019) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2019.08.012 · Cited by 1
Postoperative Rhythm Disorders After Adult Cardiac Surgeries
Haghjoo, M. (2013) · Springer eBooks · doi:10.1007/978-3-642-40418-4_9
Strategies for the Prevention of Postoperative Atrial Fibrillation in Cardiac Surgery
Matutes, E., Kathleen, A., T, J. T., Thomas, M., & Thomas, J. A. (2012) · InTech eBooks · doi:10.5772/26678
Administration d’une dose unique de dexaméthasone en anesthésie
Jakobsson, J., & Stomberg, M. W. (2011) · Le Praticien en Anesthésie Réanimation · doi:10.1016/j.pratan.2011.05.008
Effects of single dose methylprednisolone on patient recovery after cardiopulmonary bypass
Malhotra, A., Sharda, S., Kaushal, R. P., Sharma, P., Pawar, S. R., & Songra, M. (2012) · Indian Journal of Thoracic and Cardiovascular Surgery · doi:10.1007/s12055-012-0146-4
Mejía, M. G., Sandoval, A. F. B., & Acevedo, J. H. D. (2012) · Circulation · doi:10.1161/circulationaha.112.094078
LEIKKAUKSENJÄLKEISEN ETEISVÄRINÄN ESIINTYVYYS SYDÄNKIRURGISILLA POTILAILLA
Sutinen, J. (2015) · Tampere University Institutional Repository (Tampere University)
Corticosteroid Prophylaxis in Cardiac Surgery
Gore, J. M. (2009) · Journal watch · doi:10.1056/jc200905130000003
Neurologic Complications in the Cardiac Surgery Patient
Cole, S. P., & Cheung, A. T. (2015) · Advances in medical technologies and clinical practice book series · doi:10.4018/978-1-4666-8603-8.ch014
von Homeyer, P. (2015) · Advances in medical technologies and clinical practice book series · doi:10.4018/978-1-4666-8603-8.ch019
Ho, K. M., & Power, B. M. (2011) · Elsevier eBooks · doi:10.1016/b978-0-7295-3927-2.10075-2
Self-citationMoving Beyond Beta-Blockers and Amiodarone
Yanagawa, B., Friedrich, J. O., & Verma, S. (2015) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2015.12.002
Postoperative atrial fibrillation: Formulating the problem may be more challenging than the solution
Ad, N. (2017) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2017.02.040
Roseman, M., Lexchin, J., & Turner, E. H. (2017)
Gopinathannair, R. (2017) · Journal of Atrial Fibrillation · doi:10.4022/jafib.1601
Supomo, S., Aryandono, T., Soesatyo, M. H. N. E., & Sudiharto, P. (2017) · Journal of the Medical Sciences (Berkala Ilmu Kedokteran) · doi:10.19106/jmedsci004904201704
Donneyong, M. M., Kulik, A., & Gagne, J. J. (2017) · Journal of Cardiovascular Pharmacology and Therapeutics · doi:10.1177/1074248417743334
How do I prevent or treat atrial fibrillation in postoperative critically ill patients?
Frogel, J. K., & Weiss, S. J. (2020) · Elsevier eBooks · doi:10.1016/b978-0-323-64068-8.00064-x
Antiarrhythmic Properties of Non-Antiarrhythmic Drugs in Atrial Fibrillation: Upstream Therapy
Scridon, A., & Martínez‐Rubio, A. (2020) · Springer eBooks · doi:10.1007/978-3-030-34893-9_7
Ehrmann, D. E., Kaufman, J., & Gist, K. M. (2020) · Current Treatment Options in Pediatrics · doi:10.1007/s40746-020-00200-9
Efficacy and safety of corticosteroids prophylaxis in cardiac surgery
He, J., Zhang, Y., Qiu, Z., Chai, T., Fang, G., Hu, Y., Xu, F., Huang, Q., Zheng, H. W., Zhou, H., et al. (2020) · Medicine · doi:10.1097/md.0000000000023240
Metabolic and inflammatory aspects of cardiothoracic surgical interventions
Schipper, D. A. (2021) · EUR Research Repository (Erasmus University Rotterdam)
Molekulare Prinzipien in der Kardiologie: Die Basis für zukünftige Behandlungsansätze
Konradi, J., Baldus, S. E., & Pfister, R. (2015) · Deutsches Ärzteblatt · doi:10.3238/perskardio.2015.09.18.02
Editors, T. (2011) · Circulation · doi:10.1161/circulationaha.111.059758
Neurologic Complications in the Cardiac Surgery Patient
Cole, S. P., & Cheung, A. T. (2019) · IGI Global eBooks · doi:10.4018/978-1-5225-8185-7.ch015
Putra, R. G. P., Hanafy, D. A., Wartono, D. A., Busro, P. W., & Herlambang, B. (2022) · Journal Of The Indonesian Medical Association · doi:10.47830/jinma-vol.71.6-2021-746
Wang, J., Chen, B., Xie, J., Chen, H., Li, L., Zhang, W., Lü, L., & Wu, X. (2022) · Research Square · doi:10.21203/rs.3.rs-2274071/v1
Corticosteroid Insufficiency in High-Risk Surgical Patients
Annane, D., & Asehnoun, K. (2023) · Springer eBooks · doi:10.1007/978-3-031-17273-1_51
Smith, C., Lalu, M. M., & Davis, D. R. (2024) · CJC Open · doi:10.1016/j.cjco.2024.04.003
Nakamura, N. K., Hanafy, D. A., Husen, T. F., Vidya, A. P., Lopolisa, A. T., & Sugisman, S. (2024) · Cureus · doi:10.7759/cureus.71746
陈, 云. (2025) · Advances in Clinical Medicine · doi:10.12677/acm.2025.151246
Non-antiarrhythmic Drugs with Antiarrhythmic Properties
Scridon, A., Ivănescu, A. C., & Halațiu, V.-B. (2024) · Springer eBooks · doi:10.1007/978-3-031-74046-6_8
From Policy to Practice: Monitoring SDG Targets with PIRLS 2021 Austrian Data
van Staden, S., & Grobler, S. (2025) · Studia paedagogica · doi:10.5817/sp2024-3-3
Гаджимурадович, Г. К., Akchurin, R. S., Shiryaev, A. A., Евгеньевна, В. Э., Vasiliev, V. P., Мажитович, Г. Д., & Pashaev, R. (2025) · Journal of Experimental and Clinical Surgery · doi:10.18499/2070-478x-2025-18-1-19-26
Vista, G. A., Tenorio, V. J. B., & Vestal, M. V. (2025) · Philippine journal of cardiology. · doi:10.69944/pjc.b250eb6491
Fan, Y., Li, J., Luo, R., Hao, L., Yuan, C., & Jing, J. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.09.050
Renette, W., Mesotten, D., Meex, I., Hermanides, J., Rex, S., & Thiessen, S. (2025) · European Journal of Anaesthesiology Intensive Care · doi:10.1097/ea9.0000000000000088
Li, X., Shen, Z., Qi, Y., Chu, M., Wu, M., Feng, C., Liu, Z., Wang, Y., Zhang, J., Lu, X., et al. (2025) · BMC Cardiovascular Disorders · doi:10.1186/s12872-025-05203-8
Teng, H., Wang, L., Jiang, S., Jiang, T. X., Xu, L., Yan, M., Wei, H., & Lou, X. (2025) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-025-03680-8
Postoperative Rhythm Disorders After Adult Cardiac Surgery
Haghjoo, M. (2026) · Springer eBooks · doi:10.1007/978-3-032-01256-2_13
Anesthésie-réanimation en chirurgie cardiaque
Longrois, D., Gergess, A., & Provenchère, S. (2014) · Arnette eBooks · doi:10.3917/arne.fella.2014.01.0561
Zhu, D., Radosevich, M. A., Szofer-Sendrowska, A., Kowalik, M. M., Li, W., Wittwer, E. D., Diedrich, D. A., & Laudański, K. (2026) · Frontiers in Anesthesiology · doi:10.3389/fanes.2026.1898474
Metadata
- 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
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
