Methylprednisolone and inflammatory stress response in older people undergoing surgery for hip fracture: a secondary...

The inflammatory response to surgery can cause organ dysfunction that results in postoperative complications, including delirium. Methylprednisolone is an anti-inflammatory drug and could mitigate stress responses. This purpose of the study is to investigate the effects of a single high-dose methylprednisolone on various biomarkers in older people undergoing surgery for hip fractures.

In the primary study, 117 patients were included. The biomarkers investigated in this secondary analysis were interleukin (IL) -6, IL-10, troponin-T (TnT), tumor necrosis factor alpha (TNF-α), S100 calcium-binding protein B, and soluble urokinase-type plasminogen activator receptor. Blood samples were collected at four time points: (1) before the study intervention (T_before); (2) at time of surgery (T_surgery); on the (3) 1st and (4) 3rd postoperative day (T_P1 and T_P3, respectively).

Patients in the methylprednisolone group had significantly lower adjusted mean IL-6 at T_surgery and T_P1 than the placebo group [15.60 (1.13 pg/mL) vs 47.86 (1.12 pg/mL), p < 0.000 and 111.01 (31.64 pg/mL) vs 198.57 (24.00 pg/mL), p = 0.005]. Furthermore, adjusted mean TnT levels at T_surgery were lower in the methylprednisolone group [20.61 (1.14 ng/mL) vs 24.28 (1.12 ng/mL), p = 0.024) as well as adjusted mean TNF-α levels T_P1 (14.31 (1.08 pg/mL) vs 17.64 (1.04 pg/mL), p = 0.025].

In this secondary analysis, methylprednisolone had a significant effect on three biomarkers (IL-6, TnT, and TNF-α). The potential beneficial effects of methylprednisolone on inflammatory biomarkers reflecting surgical stress response in patients with hip fractures need to be investigated further.