Effects of Postoperative Glucocorticoids on Mitigation of Organ Dysfunction in Patients With Type A Aortic Dissection: A Randomized Controlled Trial

In this study, the authors evaluated the organ-protective efficacy of postoperative glucocorticoid in patients with type A aortic dissection. Patients were randomly assigned to receive either postoperative glucocorticoid or standard-of-care treatment. Intravenous methylprednisolone was administered for three days. The primary outcome was the reduction of Sequential Organ Failure Assessment (SOFA) score on postoperative day four compared to baseline (on postoperative day one, before methylprednisolone administration). A total of 212 patients (106 patients in each group) were included in the intention-to-treat analysis. The primary outcome differed significantly between groups: SOFA score reduction was 3.16 plus or minus 2.52 in the control group versus 4.36 plus or minus 2.82 in the glucocorticoid group (absolute difference 1.20 [95 percent CI 0.52–1.93], P = 0.001). The glucocorticoid group showed markedly lower median high-sensitivity C-reactive protein levels compared to the control group (91.0 mg/l vs 182.0 mg/l; absolute difference: –91 [95 percent CI –122 to –57], P = 0.009) on postoperative day four. Fewer patients in the glucocorticoid group required continuous renal replacement therapy (8.5 percent vs 19.8 percent in the control group; absolute difference: –10.4 [95 percent CI –19.1 to –1.3], P = 0.03). These findings advocate for the implementation of glucocorticoids in the early phase after type A aortic dissection surgery for enhanced organ protection.