The Effect of Methylprednisolone on Plasma Concentrations of Neutrophil Gelatinase–Associated Lipocalin in Pediatric Heart Surgery*
| Autor: | Eero Pesonen, Juho Keski-Nisula, Timo Jahnukainen, Paula Rautiainen, Ilkka Mattila, Pertti K. Suominen |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
030204 cardiovascular system & hematology Lipocalin Critical Care and Intensive Care Medicine Placebo law.invention 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine law Cardiopulmonary bypass medicine 030212 general & internal medicine Creatinine integumentary system business.industry Acute kidney injury Acute-phase protein medicine.disease 3. Good health Cardiac surgery Surgery chemistry Methylprednisolone Pediatrics Perinatology and Child Health business medicine.drug |
| Zdroj: | Pediatric Critical Care Medicine. 17:121-127 |
| ISSN: | 1529-7535 |
| Popis: | OBJECTIVES Plasma neutrophil gelatinase-associated lipocalin is a kidney injury marker used in pediatric heart surgery. Neutrophil gelatinase-associated lipocalin is also a constituent of specific granules of neutrophils. Corticosteroids are widely used in pediatric heart surgery. Methylprednisolone inhibits degranulation of neutrophil-specific granules. Use of corticosteroids has not been taken into account in studies of neutrophil gelatinase-associated lipocalin in pediatric heart surgery. We studied the influence of systemically administered methylprednisolone on plasma neutrophil gelatinase-associated lipocalin concentrations in pediatric heart surgery. DESIGN Two separate double-blinded randomized trials. SETTING PICU at a university-affiliated hospital. PATIENTS Forty neonates undergoing open-heart surgery and 45 children undergoing ventricular and atrioventricular septal defect correction. INTERVENTIONS First trial (neonate trial), 40 neonates undergoing open-heart surgery received either 30 mg/kg IV methylprednisolone (n = 20) or placebo (n = 20). Second trial (ventricular septal defect trial), 45 children undergoing ventricular or atrioventricular septal defect correction received one of the following: 30 mg/kg of methylprednisolone IV after anesthesia induction (n = 15), 30 mg/kg methylprednisolone in the cardiopulmonary bypass prime solution (n = 15), or placebo (n = 15). MEASUREMENTS AND MAIN RESULTS Plasma neutrophil gelatinase-associated lipocalin and creatinine were measured in both series. Lactoferrin levels were measured as a marker of neutrophil-specific granules in the ventricular septal defect trial only. No differences in creatinine levels occurred between the groups of either trial. Preoperative, neutrophil gelatinase-associated lipocalin did not differ between the study groups of either trial. Preoperatively administered methylprednisolone in the neonate trial reduced neutrophil gelatinase-associated lipocalin by 41% at 6 hours postoperatively (p = 0.002). Preoperatively administered methylprednisolone in the ventricular septal defect trial reduced neutrophil gelatinase-associated lipocalin by 47% (p = 0.010) and lactoferrin by 52% (p = 0.013) 6 hours postoperatively. Lactoferrin levels in the ventricular septal defect trial correlated with neutrophil gelatinase-associated lipocalin (R = 0.492; p = 0.001) preoperatively and after weaning from cardiopulmonary bypass (R = 0.471; p = 0.001). CONCLUSIONS Preoperatively administered methylprednisolone profoundly decreases plasma neutrophil gelatinase-associated lipocalin levels. Neutrophil gelatinase-associated lipocalin seems to originate to a significant extent from activated neutrophils. Preoperative methylprednisolone is a confounding factor when interpreting plasma neutrophil gelatinase-associated lipocalin levels as a kidney injury marker in pediatric heart surgery. |
| Databáze: | OpenAIRE |
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