The effect of Erythropoietin administration on the serum level of YKL-40, pro-BNP and IL-6 in coronary surgery patients

Background: Cardiopulmonary bypass and aortic clamping evokes the obligatory global myocardial ischemia and dysfunction with a significant inflammatory response. The discrepancy about cardioprotective effects of erythropoietin still exist. The aim of this study was to assess the clinical immunomodulatory effects of EPO on serum inflammatory biomarkers (YKL-40, IL-6 ) and cardiac biomarkers, (pro-BNP, CK-MB and troponin). Methods: In this randomized double blind clinical trial, 132 patients admitted for elective coronary surgery with CPB were randomly assigned in one of three groups: 1- group EPO-A (n = 35) infusion of 300 IU/Kg EPO after anesthesia induction and before undergoing CPB; 2- group EPO-CPB (n = 31) the same intervention during CPB; 3- placebo group (n = 66) saline infusion in the same volume. Cardiac enzymes and serum biomarkers were measured at intervals. Results: There was a sharp increase in serum YKL-40 with a 24 h delay after CPB in all groups without significant difference. The increase in serum IL-6 was significant in EPO-CPB group compared with both other groups (P=0.001 and P=0.001, respectively). Serum pro-BNP reached maximum level 24 hours after operation in all groups; in group A significantly less than others (p=0.008). CK-MB increased significantly in all groups (p<0.001), less prominently in CPB-A group (p=0.03). Conclusion: EPO administration before induced ischemia may be cardioprotective in terms of cardiac biomarkers in patients undergoing CABG with CPB.