Steroid Therapy Attenuates Acute Phase Reactant Response Among Children on Ventricular Assist Device Support Jonathan W. Byrnes, MD, Adnan T. Bhutta,

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Steroid Therapy Attenuates Acute Phase Reactant Response Among Children on Ventricular Assist Device Support Jonathan W. Byrnes, MD, Adnan T. Bhutta, MD, Mallikarjuna Rao Rettiganti, PhD, Alberto Gomez, BA, Xiomara Garcia, MD, Umesh Dyamenahalli, MD, MRCP(UK), Charles Johnson, CPP, Robert D.B. Jaquiss, MD, Michiaki Imamura, MD, PhD, Parthak Prodhan, MD The Annals of Thoracic Surgery Volume 99, Issue 4, Pages 1392-1398 (April 2015) DOI: 10.1016/j.athoracsur.2014.11.046 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Summary of number of steroid courses and indications for steroids over the study period. (B) Proportion of patients on ventricular assist device (VAD) and those receiving corticosteroids for systemic inflammatory response syndrome as the clinical indication. The Annals of Thoracic Surgery 2015 99, 1392-1398DOI: (10.1016/j.athoracsur.2014.11.046) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Initial therapy with steroids for systemic inflammatory response syndrome (SIRS) as a function of what day steroids were started. (B) Total episodes of steroid therapy for SIRS as a function of what day steroids were started (to reflect the multiple courses in some patients received during their ventricular assist device courses). The Annals of Thoracic Surgery 2015 99, 1392-1398DOI: (10.1016/j.athoracsur.2014.11.046) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Distribution of serum fibrinogen levels for 21 events from baseline to day 5 of corticosteroid use for systemic inflammatory response syndrome (SIRS). The estimated means along with 95% confidence intervals (CI) from the repeated measures model are also shown. (B) Distribution of C-reactive protein levels for 21 events from baseline to day 5 of corticosteroid use for SIRS. The estimated means along with 95% confidence intervals from the repeated measures model are also shown. The Annals of Thoracic Surgery 2015 99, 1392-1398DOI: (10.1016/j.athoracsur.2014.11.046) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Typical patient with recurrent systemic inflammatory response syndrome (SIRS) with depiction of C-reactive protein (CRP) and fibrinogen levels while on ventricular assist device support. Dotted line represents fibrinogen levels in milligrams/deciliter (mg/dL) with the axis on the left. Dashed line represents CRP levels in milligrams/deciliter with the axis on the right. The Annals of Thoracic Surgery 2015 99, 1392-1398DOI: (10.1016/j.athoracsur.2014.11.046) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Response of C-reactive protein (CRP) and corticosteroids when started in the immediate postoperative period. The Annals of Thoracic Surgery 2015 99, 1392-1398DOI: (10.1016/j.athoracsur.2014.11.046) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions