QP Wu and G Purusram contributed equally to this work.
The efficacy of parecoxib on systemic inflammatory response associated with cardiopulmonary bypass during cardiac surgery
Article first published online: 5 FEB 2013
© 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society
British Journal of Clinical Pharmacology
Special Issue: Nutraceuticals Themed Section
Volume 75, Issue 3, pages 769–778, March 2013
How to Cite
Wu, Q., Purusram, G., Wang, H., Yuan, R., Xie, W., Gui, P., Dong, N. and Yao, S. (2013), The efficacy of parecoxib on systemic inflammatory response associated with cardiopulmonary bypass during cardiac surgery. British Journal of Clinical Pharmacology, 75: 769–778. doi: 10.1111/j.1365-2125.2012.04393.x
- Issue published online: 5 FEB 2013
- Article first published online: 5 FEB 2013
- Accepted manuscript online: 27 JUL 2012 12:15AM EST
- Manuscript Accepted: 13 JUL 2012
- Manuscript Received: 1 FEB 2012
- National Natural Science Foundation of China. Grant Numbers: 81070060, 30930089
- cardiopulmonary bypass;
- systemic inflammatory response
Cardiopulmonary bypass (CPB) during cardiac surgery is well known to be associated with the development of a systemic inflammatory response. The efficacy of parecoxib in attenuating this systemic inflammatory response is still unknown.
Patients undergoing elective mitral valve replacement with CPB were assessed, enrolled and randomly allocated to receive parecoxib (80 mg) or placebo. Blood samples were collected in EDTA vials for measuring serum cytokine concentrations, troponin T, creatinekinase myocardial-brain isoenzyme CK-MB concentrations and white cell counts.
Compared with the control group, IL-6 and IL-8-values in the parecoxib group increased to a lesser extent, peaking at 2 h after the end of CPB (IL-6 31.8 pg ml−1 ± 4.7 vs. 77.0 pg ml−1 ± 14.1, 95% CI −47.6, −42.8, P < 0.001; IL-8 53.6 pg ml−1 ± 12.6 vs. 105.7 pg ml−1 ± 10.8, 95% CI −54.8, −49.4, P < 0.001). Peak concentrations of anti-inflammatory cytokine IL-10 occurred immediately after termination of CPB and were higher in the parecoxib group (115.7 pg ml−1 ± 10.5 vs. 88.4 pg ml−1 ± 12.3, 95% CI 24.7, 29.9, P < 0.001). Furthermore, the increase in neutrophil counts caused by CPB during cardiac surgery was inhibited by parecoxib. The increases in serum troponin T and CK-MB concentrations were also significantly attenuated by parecoxib in the early post-operative days. Peak serum concentrations of CK-MB in both groups occurred at 24 h post-CPB (17.4 μg l−1 ± 5.2 vs. 26.9 μg l−1 ± 6.9, 95% CI −10.9, −8.1, P < 0.001). Peak troponin T concentrations occurred at 6 h post-bypass (2 μg l−1 ± 0.62 vs. 3.5 μg l−1 ± 0.78, 95% CI −1.7, −1.3, P < 0.001).
Intra-operative parecoxib attenuated the systemic inflammatory response associated with CPB during cardiac surgery and lowered the biochemical markers of myocardial injury.