The effects of methylprednisolone on complement, immunoglobulins and pulmonary neutrophil sequestration during cardiopulmonary bypass. |
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| Authors: | S Dernek B Tünerir B Sevin R Aslan O Uygu? T Kural |
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| Institution: | 1. Medical student GKT School of Medical Education, Kings College London, Guy''s Campus, Hodgkin Building, Newcomen Street, London SE1 1UL, United Kingdom;2. Consultant Anaesthetist Department of Anaesthetics, King''s College Hospital NHS Trust, Denmark Hill, London SE5 9RS, United Kingdom;3. Institute of Liver Studies King''s College Hospital NHS Trust, Denmark Hill, London SE5 9RS, United Kingdom;1. IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy;2. Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy;3. IRCCS Centro Cardiologico Monzino, Via Carlo Parea, 4, 20138 Milan, Italy;4. University Hospital Dubrava, Avenija Gojka ?u?ka 6, 10000 Zagreb, Croatia;5. University North, Ul. 104. brigade 3, 42000 Vara?din, Croatia;6. National University Health System, 5 Lower Kent Ridge Rd, 119074, Singapore City, Singapore;7. Special Hospital for Cardiovascular Surgery and Cardiology Magdalena, Ul. Ljudevita Gaja 2, 49217 Krapinske Toplice, Croatia;8. Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, 31000 Osijek, Croatia;9. E.N. Meshalkin National Medical Research Center, Rechkunovskaya Ulitsa, 15, Novosibirsk, Russia;10. Sapienza Università di Roma, Piazzale Aldo Moro, 5, 00185 Rome, Italy;11. Mediterranea Cardiocentro, Via Orazio, 2, 80122 Naples, Italy;12. Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Corso Bramante, 88, 10126 Turin, Italy;13. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Via Pineta Sacchetti, 217, 00168 Rome, Italy;14. Università Cattolica del Sacro Cuore, Campus di Roma, Largo Francesco Vito, 1, 00168 Rome, Italy;15. ASO Ordine Mauriziano, Via Magellano, 1, 10128 Turin, Italy;p. Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy;q. Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152 Rome, Italy;r. A.O.R.N. “Dei Colli”, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy;s. Azienda Ospedaliero-Universitaria Sant''Andrea di Roma, Via di Grottarossa, 1035/1039, 00189 Rome, Italy;t. Azienda Ospedaliera Regionale San Carlo, Via Potito Petrone, 85100 Potenza, Italy;u. GVM - Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola (RA), Italy;v. Pineta Grande Hospital, Via Domitiana, km 30/00, 81030 Castel Volturno (CE), Italy;w. IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano (MI), Italy;x. Ospedale del Cuore, Fondazione Toscana \"Gabriele Monasterio\", Via Aurelia Sud, 54100 Massa, Italy;y. Grande Ospedale Metropolitano, Via Giuseppe Melacrino, 21, 89124 Reggio Calabria, Italy;z. Azienda Ospedaliero Universitaria Pisana, Via Roma, 67, 56126 Pisa, Italy;11. Università degli Studi di Udine, Via Palladio 8, 33100 Udine, Italy;12. Azienda Sanitaria Universitaria Friuli Centrale, Via Pozzuolo, 330, 33100 Udine, Italy;13. Department of Critical Care, The University of Melbourne, Melbourne, Australia |
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| Abstract: | In this study, the authors administered high dose (30 mg/kg body weight i.v.) methylprednisolone before cardiopulmonary bypass to observe the effects on complement, immunoglobulins and pulmonary neutrophil sequestration. Fifty patients undergoing valve replacements were included in this study. Patients were divided into two groups: group I (20 patients) served as control and did not receive methylprednisolone, group II (30 patients) received methylprednisolone. Blood samples for complements (C3c and C4) were taken, before cardiopulmonary bypass, at 5, 10 and 30 min intervals from the end of cardiopulmonary bypass, after reversal of heparin with protamine infusion, and after skin closure. Blood samples for immunoglobulins were taken before cardiopulmonary bypass, 30 min after onset of cardiopulmonary bypass and after skin closure. After onset of cardiopulmonary bypass, all C3c and C4 levels decreased in both groups. There was a significant decrease in C4 levels at end of cardiopulmonary bypass and after protamine infusion in group I compared with group II (P < 0.05). C3c levels in group I decreased significantly compared with group II after 30 min of cardiopulmonary bypass and after protamine infusion (P < 0.05). All immunoglobulin (IgG, IgM, IgA) levels were decreased in both groups, but the decrease in IgG was statistically significant after skin closure in group I compared with group II (P < 0.05). Pulmonary neutrophil sequestration was higher in the control group compared with the methyl-prednisolone group (P < 0.05). In conclusion, methylprednisolone administration before cardiopulmonary bypass may prevent the harmful effects of complement activation, immunoglobulin denaturation and neutrophil sequestration in the pulmonary capillary system. |
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