TY - JOUR

T1 - Two large preoperative doses of erythropoietin do not reduce the systemic inflammatory response to cardiac surgery

AU - Poulsen, Troels Dirch

AU - Andersen, Lars Willy

AU - Steinbrüchel, Daniel

AU - Gøtze, Jens Peter

AU - Jørgensen, Ole Steen

AU - Olsen, Niels Vidiendal

N1 - Keywords: Aged; Cardiac Surgical Procedures; Double-Blind Method; Erythropoietin, Recombinant; Female; Humans; Inflammation Mediators; Male; Middle Aged; Postoperative Complications; Preoperative Care; Prospective Studies; Time Factors

PY - 2008

Y1 - 2008

N2 - OBJECTIVES: Cardiac surgery and cardiopulmonary bypass (CPB) induce an inflammatory reaction that may lead to tissue injury. Experimental studies suggest that recombinant human erythropoietin (EPO) independent of its erythropoietic effect may be used clinically as an anti-inflammatory drug. This study tested the hypothesis that 2 large doses of EPO administered shortly before CPB ameliorate the systemic inflammatory response to CPB.DESIGN AND SETTING: A prospective, double-blind, placebo-controlled and randomized study at a single tertiary care hospital.PARTICIPANTS: Patients scheduled for coronary artery bypass graft surgery with CPB.INTERVENTIONS: EPO (epoetin alfa, 500 IU/kg intravenously, n = 22) or placebo (n = 21) was administered 12 to 18 hours preoperatively and again at the induction of anesthesia.MEASUREMENTS AND MAIN RESULTS: CPB in both groups greatly increased plasma concentrations of tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-1beta, IL-1beta receptor antagonist, IL-6, IL-10, and N-terminal probrain natriuretic peptide (NT-proBNP). Compared with placebo, EPO at day 3 after CPB augmented the TNF-alpha response (p < 0.05) and at 2 hours after CPB increased NT-proBNP (p < 0.05). Also, EPO tended to enhance the CPB-induced increase in IL-1beta receptor antagonist (p = 0.057). Otherwise, EPO had no effect on pro- and antiinflammatory mediators compared with placebo.CONCLUSIONS: Two large doses of EPO given shortly before CPB do not reduce perioperative release of inflammatory cytokines. In contrast, EPO may augment the TNF-alpha and NT-proBNP response. Although the long-term clinical impact remains unknown, the findings do not support use of EPO as an anti-inflammatory drug in patients undergoing cardiac surgery.

AB - OBJECTIVES: Cardiac surgery and cardiopulmonary bypass (CPB) induce an inflammatory reaction that may lead to tissue injury. Experimental studies suggest that recombinant human erythropoietin (EPO) independent of its erythropoietic effect may be used clinically as an anti-inflammatory drug. This study tested the hypothesis that 2 large doses of EPO administered shortly before CPB ameliorate the systemic inflammatory response to CPB.DESIGN AND SETTING: A prospective, double-blind, placebo-controlled and randomized study at a single tertiary care hospital.PARTICIPANTS: Patients scheduled for coronary artery bypass graft surgery with CPB.INTERVENTIONS: EPO (epoetin alfa, 500 IU/kg intravenously, n = 22) or placebo (n = 21) was administered 12 to 18 hours preoperatively and again at the induction of anesthesia.MEASUREMENTS AND MAIN RESULTS: CPB in both groups greatly increased plasma concentrations of tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-1beta, IL-1beta receptor antagonist, IL-6, IL-10, and N-terminal probrain natriuretic peptide (NT-proBNP). Compared with placebo, EPO at day 3 after CPB augmented the TNF-alpha response (p < 0.05) and at 2 hours after CPB increased NT-proBNP (p < 0.05). Also, EPO tended to enhance the CPB-induced increase in IL-1beta receptor antagonist (p = 0.057). Otherwise, EPO had no effect on pro- and antiinflammatory mediators compared with placebo.CONCLUSIONS: Two large doses of EPO given shortly before CPB do not reduce perioperative release of inflammatory cytokines. In contrast, EPO may augment the TNF-alpha and NT-proBNP response. Although the long-term clinical impact remains unknown, the findings do not support use of EPO as an anti-inflammatory drug in patients undergoing cardiac surgery.

KW - Aged

KW - Cardiac Surgical Procedures

KW - Double-Blind Method

KW - Erythropoietin

KW - Female

KW - Humans

KW - Inflammation Mediators

KW - Male

KW - Middle Aged

KW - Postoperative Complications

KW - Preoperative Care

KW - Prospective Studies

KW - Recombinant Proteins

KW - Time Factors

U2 - 10.1053/j.jvca.2008.08.018

DO - 10.1053/j.jvca.2008.08.018

M3 - Journal article

C2 - 18948032

VL - 23

SP - 316

EP - 323

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

IS - 3

ER -