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Updated: Feb 11, 2026

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Characterization of the Glucocorticoid Receptor in Children Undergoing Cardiac Surgery

Saul Flores1,2, David S Cooper3, Amy M Opoka2

  • 1Department of Pediatrics, Section of Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|April 21, 2018
PubMed

Insights

Increased glucocorticoid receptor levels in children after cardiac surgery correlate with a longer time off inotropes. This finding suggests a complex relationship between steroid use, receptor levels, and cardiovascular recovery in pediatric patients.

Area of Science:

  • Pediatric Cardiology
  • Endocrinology
  • Critical Care Medicine

Background:

  • Corticosteroids are frequently used post-cardiac surgery for low cardiac output syndrome.
  • Glucocorticoid receptor (GR) activity is central to corticosteroid function.
  • Understanding GR levels is crucial for optimizing treatment in pediatric cardiac surgery patients.

Purpose of the Study:

  • To measure GR levels in children undergoing cardiac surgery.
  • To investigate the association between GR levels and cardiovascular dysfunction, specifically time to inotrope independence.

Main Methods:

  • Prospective observational cohort study of 83 children with congenital heart disease.
  • Peripheral white blood cell (WBC) GR levels measured by flow cytometry.
  • Cortisol levels monitored; time to inotrope free was the primary outcome.

Main Results:

  • An increase in GR levels from postoperative day 1 to day 3 was linked to a longer time to inotrope independence (HR 0.49; p=0.01).
  • This association remained significant after adjusting for clinical factors (HR 0.53; p=0.05).
  • Postoperative day 3 GR levels showed a trend towards longer inotrope-free time (HR 0.66; p=0.06).

Conclusions:

  • Higher GR levels in pediatric cardiac surgery patients correlate with improved cardiovascular recovery.
  • Minimal cortisol level changes were observed and did not correlate with GR levels.
  • Results suggest potential HPA axis suppression from perioperative steroids, necessitating further research into GR, cortisol, and inotropic support interactions.
Abstract

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