Meta-Analysis: Shouldn’t Prophylactic Corticosteroids be Administered During Cardiac Surgery with Cardiopulmonary Bypass?

Background Corticosteroids can effectively inhibit systemic inflammation induced by cardiopulmonary bypass. Recently clinical trials and meta-analyses and current guidelines for cardiac surgery do not support corticosteroids prophylaxis during cardiac surgery because of an increase in myocardial infarction and no benefit for patients. The aim of this study is to determine whether specific corticosteroids dose ranges might provide clinical benefits without increasing myocardial infarction. Methods The PubMed, Web of Science, Embase, Clinical Trials, and Cochrane databases were searched for randomized controlled trials (RCTs) published before August 1, 2021. Results 88 RCTs with 18,416 patients (17,067 adults and 1,349 children) were identified. Relative to placebo and high-dose corticosteroids, low-dose corticosteroids (≤20 mg/kg hydrocortisone) during adult cardiac surgery did not increase the risks of myocardial infarction (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.43–2.17; p = 0.93). However, low-dose corticosteroids were associated with lower risks of atrial fibrillation (OR: 0.58, 95% CI: 0.44–0.76; p < 0.0001) and kidney injury (OR: 0.29, 95% CI: 0.09–0.96; p = 0.04). Furthermore, low-dose corticosteroids significantly shortened the mechanical ventilation times (mean difference [MD]: −2.74 h, 95% CI: −4.14, −1.33; p = 0.0001), intensive care unit (ICU) stay (MD: −1.48 days, 95% CI: −2.73, −0.22; p = 0.02), and hospital stay (MD: −2.29 days, 95% CI: −4.51, −0.07; p = 0.04). Conclusion Low-dose corticosteroids prophylaxis during cardiac surgery provided significant benefits for adult patients, without increasing the risks of myocardial infarction and other complications.

• Publication year

  2022

• Venue

  Frontiers in Surgery

• Publication date

  2022-06-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.3389/fsurg.2022.832205PMID 35722531PMCID 9198450
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• The efficacy and safety of prophylactic corticosteroids for the prevention of adverse outcomes in patients undergoing heart surgery using cardiopulmonary bypass: a systematic review and meta-analysis of randomized controlled trials.

  2020influential reference
• Effect of Intraoperative Dexamethasone on Major Complications and Mortality Among Infants Undergoing Cardiac Surgery: The DECISION Randomized Clinical Trial.

  2020cited by this paper
• Extracorporeal Hemadsorption versus Glucocorticoids during Cardiopulmonary Bypass: A Prospective, Randomized, Controlled Trial

  2020cited by this paper
• Reduction of Inflammation by High-Dose Methylprednisolone Does not Attenuate Oxidative Stress in Children Undergoing Bidirectional Glenn Procedure With or Without Aortic Arch or Pulmonary Arterial Repair.

  2019cited by this paper
• Corticosteroid Therapy in Neonates Undergoing Cardiopulmonary Bypass: Randomized Controlled Trial.

  2019cited by this paper
• Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions.

  2019cited by this paper
• 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery.

  2019cited by this paper
• The effect of methylprednisolone prophylaxis on inflammatory monocyte subsets and suppressive regulatory T cells of patients undergoing cardiopulmonary bypass

  2019cited by this paper
• The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality.

  2019influential reference
• Effects of methylprednisolone on blood-brain barrier and cerebral inflammation in cardiac surgery—a randomized trial

  2018cited by this paper
• Preinterventional hydrocortisone sustains the endothelial glycocalyx in cardiac surgery

  2018cited by this paper
• 3275Short term use of corticosteroids in the prophylaxis of atrial fibrillation after cardiac surgery and impact on the levels of acute phase proteins in this context

  2018cited by this paper
• Efficacy of corticosteroids in prevention of acute kidney injury in neonates undergoing cardiac surgery—A randomized controlled trial

  2018cited by this paper
• Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations: A Randomized Controlled Trial.

  2017cited by this paper
• High‐dose methylprednisolone and endothelial glycocalyx in paediatric heart surgery

  2016cited by this paper
• Use of short-term steroids in the prophylaxis of atrial fibrillation after cardiac surgery

  2016cited by this paper
• Molecular Actions of Glucocorticoids in Cartilage and Bone During Health, Disease, and Steroid Therapy.

  2016cited by this paper
• Effect of timing and route of methylprednisolone administration during pediatric cardiac surgical procedures.

  2015cited by this paper
• Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial.

  2015influential reference
• Antiplatelet therapy: Vorapaxar in diabetes and MI

  2015cited by this paper
• Effect of steroids on inflammatory markers and clinical parameters in congenital open heart surgery: a randomised controlled trial

  2015cited by this paper
• Pretreatment with methylprednisolone improves myocardial protection during on-pump coronary artery bypass surgery.

  2015cited by this paper
• Hyperglycemia Inhibits Cardiac Stem Cell–Mediated Cardiac Repair and Angiogenic Capacity

  2014cited by this paper
• Hexokinase–mitochondrial interactions regulate glucose metabolism differentially in adult and neonatal cardiac myocytes

  2013cited by this paper
• Methylprednisolone in neonatal cardiac surgery: reduced inflammation without improved clinical outcome.

  2013cited by this paper
• Methylprednisolone use is associated with endothelial cell activation following cardiac surgery.

  2013cited by this paper
• Prophylaxis of dexamethasone protects patients from further post-operative delirium after cardiac surgery: A randomized trial

  2013cited by this paper
• The effect of dexamethasone prophylaxis on postoperative delirium after cardiac surgery: a randomized trial

  2012cited by this paper
• Dexamethasone pretreatment provides antiinflammatory and myocardial protection in neonatal arterial switch operation.

  2012cited by this paper
• Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial.

  2012influential reference
• Perioperative intravenous corticosteroids reduce incidence of atrial fibrillation following cardiac surgery: a randomized study.

  2012cited by this paper
• Steroids and statins: an old and a new anti-inflammatory strategy compared

  2011cited by this paper
• Small-dose dexamethasone improves quality of recovery scores after elective cardiac surgery: a randomized, double-blind, placebo-controlled study.

  2011cited by this paper
• Effects of Dexamethasone on Pulmonary and Renal Functions in Patients Undergoing CABG With Cardiopulmonary Bypass

  2009cited by this paper
• Influence of Methylprednisolone on Levels of Neuron‐Specific Enolase in Cardiac Surgery: A Corticosteroid Derivative to Decrease Possible Neuronal Damage

  2009cited by this paper
• Journal of Cardiothoracic Surgery BioMed Central

  2009cited by this paper
• Stress doses of hydrocortisone in high-risk patients undergoing cardiac surgery: Effects on interleukin-6 to interleukin-10 ratio and early outcome*

  2009cited by this paper
• Benefits and Risks of Corticosteroid Prophylaxis in Adult Cardiac Surgery: A Dose-Response Meta-Analysis

  2009cited by this paper
• The effect of combined preinduction thoracic epidural anaesthesia and glucocorticoid administration on perioperative interleukin-10 levels and hyperglycemia. A randomized controlled trial.

  2008cited by this paper
• Reducing the Effects of the Systemic Inflammatory Response to Cardiopulmonary Bypass: Can Single Dose Steroids Blunt Systemic Inflammatory Response Syndrome?

  2008cited by this paper
• Understanding the inflammatory response to cardiac surgery.

  2008cited by this paper
• Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass: a meta-analysis of randomized trials.

  2008cited by this paper
• Cardiopulmonary and systemic effects of methylprednisolone in patients undergoing cardiac surgery.

  2007cited by this paper
• Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial.

  2007cited by this paper
• Effect of dexamethasone on atrial fibrillation after cardiac surgery: prospective, randomized, double-blind, placebo-controlled trial.

  2007cited by this paper
• Stress doses of hydrocortisone reduce chronic stress symptoms and improve health-related quality of life in high-risk patients after cardiac surgery: a randomized study.

  2006cited by this paper
• Minor Infection Encouraged by Steroid Administration during Cardiac Surgery

  2006cited by this paper
• Pulse low dose steroids attenuate post-cardiopulmonary bypass SIRS; SIRS I.

  2006cited by this paper
• The acute cardioprotective effect of glucocorticoid in myocardial ischemia–reperfusion injury occurring during cardiopulmonary bypass

  2006cited by this paper
• The effects of steroids on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: a prospective randomized trial.

  2005cited by this paper
• Steroid supplementation: a legitimate pharmacotherapy after neonatal open heart surgery.

  2005cited by this paper
• Effects of methylprednisolone and a biocompatible copolymer circuit on blood activation during cardiopulmonary bypass.

  2005cited by this paper
• The Effect of Oral Prednisolone with Chronic Obstructive Pulmonary Disease Undergoing Coronary Artery Bypass Surgery

  2005cited by this paper
• Dexamethasone: benefit and prejudice for patients undergoing on-pump coronary artery bypass grafting: a study on myocardial, pulmonary, renal, intestinal, and hepatic injury.

  2005cited by this paper
• Hemofiltration but Not Steroids Results in Earlier Tracheal Extubation following Cardiopulmonary Bypass: A Prospective, Randomized Double-blind Trial

  2004cited by this paper
• Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study.

  2004cited by this paper
• The effect of methylprednisolone treatment on the cardiopulmonary bypass-induced systemic inflammatory response.

  2004cited by this paper
• Methylprednisolone prevents inflammatory reaction occurring during cardiopulmonary bypass: effects on TNF-α, IL-6, IL-8, IL-10

  2004cited by this paper
• Methylprednisolone favourably alters plasma and urinary cytokine homeostasis and subclinical renal injury at cardiac surgery.

  2004cited by this paper
• Effect of dexamethasone on perioperative renal function impairment during cardiac surgery with cardiopulmonary bypass.

  2004cited by this paper
• The Effect of Dexamethasone on Side Effects After Coronary Revascularization Procedures

  2003cited by this paper
• Myocardial and lung injury after cardiopulmonary bypass: role of interleukin (IL)-10.

  2003cited by this paper
• Effects of different steroid treatment on reperfusion‐associated production of reactive oxygen species and arrhythmias during coronary surgery

  2003cited by this paper
• Dexamethasone reduces postoperative troponin levels in children undergoing cardiopulmonary bypass.

  2003cited by this paper
• Effects of dexamethasone on clinical course, C-reactive protein, S100B protein and von Willebrand factor antigen after paediatric cardiac surgery.

  2003cited by this paper
• Cardiopulmonary bypass, steroid administration, and surgical injury synergistically impair memory T cell function and antigen presentation.

  2003cited by this paper
• Stress doses of hydrocortisone reduce severe systemic inflammatory response syndrome and improve early outcome in a risk group of patients after cardiac surgery

  2003cited by this paper
• Glucocorticoid effects on the inflammatory and clinical responses to cardiac surgery.

  2002cited by this paper
• Dexamethasone decreases the pro- to anti-inflammatory cytokine ratio during cardiac surgery.

  2002cited by this paper
• Effects of Dexamethasone on Intravascular and Extravascular Fluid Balance in Patients Undergoing Coronary Bypass Surgery with Cardiopulmonary Bypass

  2002cited by this paper
• Corticosteroids and cardiopulmonary bypass : a review of clinical investigations.

  2002cited by this paper
• Influence of aminosteroid and glucocorticoid treatment on inflammation and immune function during cardiopulmonary bypass

  2001cited by this paper
• The effect of short-term prophylactic methylprednisolone on the incidence and severity of postpericardiotomy syndrome in children undergoing cardiac surgery with cardiopulmonary bypass.

  2001cited by this paper
• The effects of aprotinin and steroids on generation of cytokines during coronary artery surgery.

  2001cited by this paper
• The effects of glucocorticoid therapy on inflammatory responses to coronary artery bypass graft surgery.

  2001cited by this paper
• MODULATING IL‐6 AND IL‐10 LEVELS BY PHARMACOLOGIC STRATEGIES AND THE IMPACT OF DIFFERENT EXTRACORPOREAL CIRCULATION PARAMETERS DURING CARDIAC SURGERY

  2001cited by this paper
• [Effects of dexamethasone on extravascular lung water and pulmonary haemodynamics in patients undergoing coronary artery bypass surgery].

  2001cited by this paper
• Methylprednisolone does not benefit patients undergoing coronary artery bypass grafting and early tracheal extubation.

  2001cited by this paper
• Effects of dexamethasone on extravascular lung water and pulmonary haemodynamics in patients undergoing coronary artery bypass surgery

  2001cited by this paper
• Preoperative administration of steroids: influence on adhesion molecules and cytokines after cardiopulmonary bypass.

  2001cited by this paper
• Dexamethasone reduces the inflammatory response to cardiopulmonary bypass in children.

  2000cited by this paper
• Effects of single dose, postinduction dexamethasone on recovery after cardiac surgery.

  2000cited by this paper
• Reducing the Post-Pump Syndrome by Using Heparin-Coated Circuits, Steroids, or Aprotinin

  1999cited by this paper
• Does high-dose methylprednisolone in aprotinin-treated patients attenuate the systemic inflammatory response during coronary artery bypass grafting procedures?

  1999cited by this paper
• Does steroid pretreatment increase endotoxin release during clinical cardiopulmonary bypass?

  1999cited by this paper
• Hemodynamic effects of methylprednisolone in patients undergoing cardiac operation and early extubation.

  1999cited by this paper
• Effect of low-dose methyl prednisolone on serum cytokine levels following extracorporeal circulation

  1999cited by this paper
• Dexamethasone Decreases the Incidence of Shivering After Cardiac Surgery: A Randomized, Double-Blind, Placebo-Controlled Study

  1998cited by this paper
• Pulmonary Effects of Methylprednisolone in Patients Undergoing Coronary Artery Bypass Grafting and Early Tracheal Extubation

  1998cited by this paper
• Effect of methylprednisolone on the oxidative burst activity, adhesion molecules and clinical outcome following open heart surgery.

  1997cited by this paper
• Synergistic immunosuppression caused by high-dose methylprednisolone and cardiopulmonary bypass.

  1997cited by this paper
• Acute-phase responses to cardiopulmonary bypass in children weighing less than 10 kilograms.

  1996cited by this paper
• Assessing the quality of reports of randomized clinical trials: is blinding necessary?

  1996cited by this paper
• The effect of methylprednisolone, given prior to cardiopulmonary bypass, on indices of gas exchange

  1996cited by this paper
• Influence of steroids on complement and cytokine generation after cardiopulmonary bypass.

  1995cited by this paper
• Steroid inhibition of cytokine-mediated vasodilation after warm heart surgery.

  1995cited by this paper
• Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass.

  1991cited by this paper
• Effect of methylprednisolone on endotoxemia and complement activation during cardiac surgery.

  1989cited by this paper
• Complement activation during cardiopulmonary bypass. Comparison of bubble and membrane oxygenators.

  1986cited by this paper
• The Effect of Methylprednisolone on Complement Activation during Cardiopulmonary Bypass

  1984cited by this paper

• The Effects of Dexamethasone in Cardiac Surgery: A Registry-Based, Real-World Data Analysis of Clinical Outcomes From the Netherlands Heart Registration.

  2025cites this paper
• Knowledge domains and hotspots in corticosteroid use for cardiac surgery: a 23-Year bibliometric and visualized analysis

  2025cites this paper
• Inflammation pathways as therapeutic targets in angiotensin II induced atrial fibrillation

  2025cites this paper
• Cardiopulmonary bypass and VA-ECMO induced immune dysfunction: common features and differences, a narrative review

  2024cites this paper
• Prophylactic corticosteroids for cardiac surgery in children: A systematic review and meta-analysis.

  2023cites this paper
• Pulmonary reperfusion injury in post-palliative intervention of oligaemic cyanotic CHD: a new catastrophic consequence or just revisiting the same old story?

  2023cites this paper
• Sistemik Otoimmün Hastalık Tanılı Hastalarda Koroner Arter Bypass Greftleme Cerrahisi

  2023cites this paper
• Enhanced recovery after surgery program for patients undergoing isolated elective coronary artery bypass surgery improves postoperative outcomes.

  2023cites this paper
• Vasoplegic Syndrome after Cardiopulmonary Bypass in Cardiovascular Surgery: Pathophysiology and Management in Critical Care

  2022cites this paper
• CORONARY ARTERY BYPASS GRAFTING SURGERY FOR PATIENTS WITH SYSTEMIC AUTOIMMUNE DISEASES: INSTITUTIONAL EXPERIENCE

  year unknowncites this paper