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.
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“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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Measuring inconsistency in meta-analyses
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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
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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
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Research works printed but not linked: 3
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Guidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq278 · Cited by 5,924
Guidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · EP Europace · doi:10.1093/europace/euq350 · Cited by 1,764
Inflammation and the pathogenesis of atrial fibrillation
Hu, Y., Chen, Y., Lin, Y., & Chen, S. (2015) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2015.2 · Cited by 1,122
Postoperative atrial fibrillation: mechanisms, manifestations and management
Dobrev, D., Aguilar, M., Heijman, J., Guichard, J.-B., & Nattel, S. (2019) · Nature Reviews Cardiology · doi:10.1038/s41569-019-0166-5 · Cited by 645
Role of Inflammation in Atrial Fibrillation Pathophysiology and Management
Harada, M., Wagoner, D. R. V., & Nattel, S. (2015) · Circulation Journal · doi:10.1253/circj.cj-15-0138 · Cited by 481
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
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