LAUSR

Learning Objectives: Corticosteroids are frequently administered, as a strategy to immunomodulate one’s body response to stress, during the perioperative phase in children undergoing cardiac surgery. The activity of corticosteroids depends on the glucocorticoid receptor (GCR) and, recently, increased GCR levels had been associated with worse clinical outcomes irrespective of cortisol levels in this patient population. Based on this evidence, we conducted a posthoc analysis to characterize GCR levels and associate it with Vasoactive Inotrope Score, the commonly used marker of severity in cardiac surgery. We hypothesized that glucocorticoid receptor (GCR) expression will be associated with vasoactive inotropic score (VIS). Methods: The prospective cohort from a single pediatric care center, undergoing corrective or palliative cardiac surgery requiring cardiopulmonary bypass (CPB). GCR expression in white blood cells was measured using flow cytometry of blood samples collected immediately before and at 24 and 72 hours post-operatively. Linear mixed modelling was conducted to examine association between GCR cell expression and VIS. Results: Eighty-three patients were enrolled. The incidence of AKI was 19%. Mortality was observed in 3 patients (3.6%). For postoperative day (POD) 1, VIS (median) was 8 [IQR, 5.8–13.5], for POD 2 VIS was 7.8 [IQR, 5–14] and POD 3 VIS was 7 [IQR, 5–9]. Examining GCR levels longitudinally for all three study days, negative association was observed between GCR and VIS scores [β-estimates ± SE (-0.12 ± 0.061), p=0.05] adjusting for significant covariates. The multivariable association when examined individually for each study day, 72 hours GCR levels showed positive association with VIS [0.455 ± 0.21, p=0.04]. Conclusions: Our study suggests that when examining all 3 study days longitudinally, increase in GCR levels were associated with decrease in VIS scores in univariate and multivariable analyses. However, examining this association by individual study days, increased GCR levels on POD 3 was associated with increased VIS scores. Future analysis in this cohort of patients will focus on additional outcome measures as well as studying glucocorticoid receptor expression variability, isoform distribution, and interactions with post-operative prescription of corticosteroids. CCMCritical Care MedicineCrit Care Med0090-3493Lippincott Williams & WilkinsHagerstown, MD CCM