Steroid Therapy Attenuates Acute Phase Reactant Response among Children on Ventricular Assist Device Support

Jonathan W. Byrnes, Adnan T. Bhutta, Mallikarjuna Rao Rettiganti, Alberto Gomez, Xiomara Garcia, Umesh Dyamenahalli, Charles Johnson, Robert D B Jaquiss, Michiaki Imamura, Parthak Prodhan

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Hyperfibrinogenemia, which can create a procoagulant milieu, is frequently observed in patients supported with the Berlin EXCOR (Berlin Heart GmbH, Berlin, Germany) ventricular assist device (VAD). We began initiating corticosteroids in patients with systemic inflammatory response syndrome (SIRS) episodes to mitigate hyperfibrinogenemia. We set forth to describe the impact of corticosteroids on the hyperfibrinogenemic state in our institutional experience. Methods Retrospective data was collected on 44 consecutive patients implanted with the Berlin EXCOR VAD from April 15, 2005 through May 6, 2013. Pertinent information was abstracted from the electronic medical record. The reduction of C-reactive protein (CRP) and fibrinogen levels among days from corticosteroid treatment were described. Infections and insulin use were reported based on whether patients received steroids and if steroids were given for SIRS. Results Over the initial 44 Berlin EXCOR VAD implantations, 14 patients were treated with 21 courses of corticosteroids for SIRS episodes as identified by clinical features and rise in CRP. Treatment with corticosteroids reduced fibrinogen levels by day 2 to a statistically significant degree (p = 0.008). No difference in hyperglycemia or infections occurred among patients receiving corticosteroids for SIRS. Conclusions Treatment with corticosteroids can potentially mitigate the SIRS response among children supported on the Berlin EXCOR VAD. In patients who received corticosteroids to mitigate inflammation, there was no increase in infections or hyperglycemia requiring insulin administration compared with patients who did not receive steroids.

Original languageEnglish (US)
Pages (from-to)1392-1398
Number of pages7
JournalAnnals of Thoracic Surgery
Volume99
Issue number4
DOIs
StatePublished - Jan 1 2015

Fingerprint

Acute-Phase Reaction
Heart-Assist Devices
Acute-Phase Proteins
Adrenal Cortex Hormones
Berlin
Systemic Inflammatory Response Syndrome
Steroids
Therapeutics
Hyperglycemia
C-Reactive Protein
Fibrinogen
Infection
Insulin
Electronic Health Records
Germany
Inflammation

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Byrnes, J. W., Bhutta, A. T., Rettiganti, M. R., Gomez, A., Garcia, X., Dyamenahalli, U., ... Prodhan, P. (2015). Steroid Therapy Attenuates Acute Phase Reactant Response among Children on Ventricular Assist Device Support. Annals of Thoracic Surgery, 99(4), 1392-1398. https://doi.org/10.1016/j.athoracsur.2014.11.046

Steroid Therapy Attenuates Acute Phase Reactant Response among Children on Ventricular Assist Device Support. / Byrnes, Jonathan W.; Bhutta, Adnan T.; Rettiganti, Mallikarjuna Rao; Gomez, Alberto; Garcia, Xiomara; Dyamenahalli, Umesh; Johnson, Charles; Jaquiss, Robert D B; Imamura, Michiaki; Prodhan, Parthak.

In: Annals of Thoracic Surgery, Vol. 99, No. 4, 01.01.2015, p. 1392-1398.

Research output: Contribution to journalArticle

Byrnes, JW, Bhutta, AT, Rettiganti, MR, Gomez, A, Garcia, X, Dyamenahalli, U, Johnson, C, Jaquiss, RDB, Imamura, M & Prodhan, P 2015, 'Steroid Therapy Attenuates Acute Phase Reactant Response among Children on Ventricular Assist Device Support', Annals of Thoracic Surgery, vol. 99, no. 4, pp. 1392-1398. https://doi.org/10.1016/j.athoracsur.2014.11.046
Byrnes, Jonathan W. ; Bhutta, Adnan T. ; Rettiganti, Mallikarjuna Rao ; Gomez, Alberto ; Garcia, Xiomara ; Dyamenahalli, Umesh ; Johnson, Charles ; Jaquiss, Robert D B ; Imamura, Michiaki ; Prodhan, Parthak. / Steroid Therapy Attenuates Acute Phase Reactant Response among Children on Ventricular Assist Device Support. In: Annals of Thoracic Surgery. 2015 ; Vol. 99, No. 4. pp. 1392-1398.
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