Methylprednisolone and the Systemic Inflammatory Response Syndrome

Abstract

We read with great interest the recent article by Sumida et al. (1) describing their work with methylprednisolone and the systemic inflammatory response syndrome. In their clinical model of intraperitoneal hyperthermic perfusion-induced systemic inflammatory response syndrome, they found that pretreatment with IV methylprednisolone (50 mg/kg, total) attenuated the increase in circulating tumor necrosis factor-α and prevented pulmonary dysfunction as assessed by lung injury scores (which incorporated a chest radiograph score, a hypoxemia score, and a positive end-expiratory pressure score) (1). They also found that the systemic vascular resistance was significantly decreased, and the cardiac index was significantly increased in the methylprednisolone-pretreated group, and they postulate that the drug may attenuate tumor necrosis factor-α-induced vasoconstriction or directly dilate resistance vessels (1). We have recently studied the pulmonary and hemodynamic effects of methylprednisolone in patients undergoing cardiac surgery with cardiopulmonary bypass (which initiates the systemic inflammatory response syndrome) (2,3). Like Sumida et al., we found that pretreatment with IV methylprednisolone (60 mg/kg, total) significantly decreased systemic vascular resistance and significantly increased cardiac index in the immediate postoperative period (2,3). However, unlike Sumida et al., in our clinical model of the systemic inflammatory response syndrome, methylprednisolone induced pulmonary dysfunction in the immediate postoperative period (significantly larger increases in alveolar-arterial oxygen gradient and significantly prolonged extubation time) (2,3). We did not assess circulating tumor necrosis factor-α levels in our study; yet we found that methylprednisolone was unable to attenuate complement activation associated with cardiopulmonary bypass (2,3). It is apparent that methylprednisolone may benefit certain patients who experience the systemic inflammatory response syndrome. However, further study is required before specific indications are clear. Mark A. Chaney MD Mihail P. Nikolov MD