• Rosario Losiggio, Vladimir Lomivorotov, Jacopo D'Andria Ursoleo, Yuki Kotani, Fabrizio Monaco, Milan Milojevic, Andrey Yavorovskiy, Todd C Lee, Giovanni Landoni, and Steroids Group.
• Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
• J. Cardiothorac. Vasc. Anesth. 2024 Nov 1; 38 (11): 278327912783-2791.

ObjectiveCardiac surgery can be complicated by the development of a systemic inflammatory response syndrome related to cardiopulmonary bypass. This potentially contributes to the occurrence of postoperative morbidity and mortality. Corticosteroids can be used to reduce such inflammation, but the overall balance between potential harm and benefit is unknown and may be age-dependent. The present meta-analysis aims to evaluate the effects of prophylactic corticosteroids in pediatric and non-elderly adult cardiac surgery patients.DesignSystematic review and meta-analysis of randomized trials.SettingCardiac surgery with cardiopulmonary bypass.ParticipantsPatients younger than 65 years old (pediatric and non-elderly adults).InterventionsPerioperative use of corticosteroids versus placebo or standard care.Measurements And Main ResultsTwo independent investigators searched PubMed, EMBASE and the Cochrane Library from inception to January 20, 2024. The primary outcome was mortality at the longest follow-up available. Secondary outcomes included acute kidney injury, atrial fibrillation, myocardial injury, cerebrovascular events, and infections. Our search strategy identified a total of 17 randomized trials involving 6,598 patients. Mortality was significantly reduced in the corticosteroid group (78/3321 [2.3%] vs. 116/3277 [3.5%]; risk ratio = 0.69; 95% confidence interval, 0.52 to 0.92; P = 0.01; I2 = 0%; NNT = 91). Moreover, the highest postoperative vasoactive inotropic score (VIS) was significantly lower in corticosteroid group (MD: -2.07, 95% CI -3.69 to -0.45, P = 0.01, I2 = 0%). No significant differences in secondary outcomes between the two treatment groups were recorded.ConclusionsThis meta-analysis of randomized trials highlights the potential benefits of corticosteroids on survival in cardiac surgery for patients younger than 65 years old.Copyright © 2024 Elsevier Inc. All rights reserved.

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