Influence of methylprednisolone on cytokine balance during cardiac surgery

Objective: To determine the influence of methylprednisolone on the cytokine balance during cardiac surgery. Design: Prospective, randomized, nonblinded study. Setting: University hospital. Patients: Twenty-one patients on cardiopulmonary bypass undergoing aortocor onary bypass surgery. Interventions: According to a randomized sequence, the patients either rece ived methylprednisolone (30 mu g/kg) before cardiopulmonary bypass and befo re declamping of the aorta (MPS group, n = 11)or received nothing (control group, n = 10). Measurements and Main Results: Serum proinflammatory cytokines (interleukin [IL]-8, IL-6) and anti-inflammatory cytokines (IL-10, IL-1ra) were measure d by enzyme-linked immunosorbent assays. Serum IL-6 and IL-8 concentrations in the control group (15.2 +/- 4.1 and 14.1 +/- 1.9 pg/mL, preoperatively) increased to 242 +/- 70.1 and 97.3 +/- 18.3 pg/mL at 60 mins after declamp ing of the aorta (p < .01, p < .01, respectively). The increases were great er than those from 2.5 +/- 0.6 and 2.5 +/- 0.5 pg/mL to 109.5 +/- 29.0 and 33 +/- 4.1 pg/mL in the MPS group for IL-6 and IL-8, respectively. Serum IL 10 concentrations increased significantly 60 mins after declamping of the aorta compared with its preoperative value in the two groups (the control g roup, from 1.0 +/- 0 to 537.9 +/- 61.7 pg/mL; the MPS group, from 0.3 +/- 0 .2 to 654.9 +/- 24 pg/mL [p < .01, p < .01, respectively]). No difference w as found between the two groups. Similarly, serum IL-1ra concentrations in the two groups increased the preoperative value in the control group from 3 04 +/- 120 to 44,374 +/- 14,631 pg/mL and in the MPS group from 616.5 +/- 1 09.6 to 35,598 +/- 9,074 pg/mL at 60 mins after declamping of the aorta (p < .01, p < .01, respectively). There was no difference between the two grou ps. Conclusions: Methylprednisolone reduces the production of IL-6 and IL-8 but not that of IL-10 and IL-l ra. These results suggest that one of the mecha nisms of the cytoprotective effect of methylprednisolone may be to make cha nges in the proinflammatory and anti-inflammatory cytokine balance.