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Cortisol antiinflammatory effects are maximal at postoperative plasma concentrations
Mark P Yeager1, Athos J Rassias, Mary P Fillinger
1Department of Anesthesiology, Dartmouth Medical School, Hanover, NH, USA.
Critical Care Medicine
|July 9, 2005
Summary
Hydrocortisone effectively suppresses inflammation after cardiac surgery. Higher doses do not further reduce interleukin-6, suggesting a saturable effect at typical post-surgery cortisol levels.
Area of Science:
- Cardiology
- Immunology
- Pharmacology
Background:
- Cardiac surgery with cardiopulmonary bypass triggers a systemic inflammatory response.
- Cortisol plays a crucial role in modulating inflammatory and anti-inflammatory pathways.
Purpose of the Study:
- To determine the optimal plasma cortisol concentration for suppressing the inflammatory response to cardiac surgery.
- To investigate the dose-response relationship of hydrocortisone in mitigating surgical inflammation.
Main Methods:
- Prospective, randomized, double-blind clinical trial involving 60 cardiac surgical patients.
- Patients received varying intravenous hydrocortisone doses to maintain specific plasma cortisol levels, with etomidate suppressing endogenous production.
- Plasma levels of interleukin-6 (inflammatory marker) and interleukin-10 (anti-inflammatory marker) were monitored.
Main Results:
- A hydrocortisone dose maintaining plasma cortisol at 40-50 microg/dL significantly suppressed interleukin-6 and increased interleukin-10 post-surgery compared to controls.
- Increasing the hydrocortisone dose did not further suppress interleukin-6, indicating a saturable effect.
- Higher hydrocortisone doses led to a further increase in interleukin-10 levels.
Conclusions:
- Cortisol-induced suppression of interleukin-6 during and after cardiac surgery is a saturable phenomenon.
- The effective plasma cortisol concentration for maximal anti-inflammatory effect appears to be similar to levels naturally occurring post-surgery in untreated patients.