37638
document
Two large preoperative doses of erythropoietin do not reduce the systemic inflammatory response to cardiac surgery . 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 .
37639
Intervention_Pharmacological
erythropoietin
37640
Intervention_Pharmacological
recombinant human erythropoietin ( EPO )
37641
Intervention_Pharmacological
EPO
37642
Intervention_Control
placebo-controlled
37643
Intervention_Pharmacological
EPO ( epoetin alfa
37644
Intervention_Control
placebo
37645
Intervention_Control
placebo , EPO
37646
Intervention_Pharmacological
EPO
37647
Intervention_Pharmacological
EPO
37648
Intervention_Pharmacological
EPO
37649
Intervention_Pharmacological
EPO
37650
Intervention_Pharmacological
EPO
37651
Outcome_Physical
plasma concentrations of tumor necrosis factor alpha ( TNF-alpha )
37652
Outcome_Physical
interleukin ( IL ) -1beta
37653
Outcome_Physical
IL-1beta receptor antagonist , IL-6
37654
Outcome_Physical
IL-10
37655
Outcome_Physical
N-terminal probrain natriuretic peptide ( NT-proBNP )
37656
Outcome_Mental
TNF-alpha response
37657
Outcome_Physical
IL-1beta receptor antagonist
37658
Outcome_Physical
pro- and antiinflammatory mediators
37659
Outcome_Physical
perioperative release of inflammatory cytokines
37660
Participant_Condition
systemic inflammatory response to cardiac surgery .