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Resuscitation. 2016 Jun;103:117-124. doi: 10.1016/j.resuscitation.2016.01.006. Epub 2016 Jan 27.

Inflammatory markers following resuscitation from out-of-hospital cardiac arrest-A prospective multicenter observational study.

Author information

1
Department of Internal Medicine and Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: mpeberdy@aol.com.
2
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
3
Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.
4
Department of Nursing, Virginia Commonwealth University, Richmond, VA, USA.
5
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
6
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
7
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
8
Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA.
9
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
10
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Abstract

AIM:

The post-cardiac arrest syndrome is a complex set of pathophysiological processes including a systemic inflammatory response. The goal of the current investigation was to test the hypothesis that early inflammatory markers are independently associated with in-hospital mortality and poor neurological outcome in patients initially resuscitated from out-of-hospital cardiac arrest.

METHODS:

This was a preplanned analysis of data collected from a prospective observational multicenter study in adult out-of-hospital cardiac arrest patients. Blood was drawn at baseline, 12 and 24h after return of spontaneous circulation and plasma levels of interleukin (IL)-1β, IL-1 receptor antagonist (IL-1Ra), IL-6, IL-8, IL-10 and tumor necrosis factor (TNF)-α were measured. The primary outcome measure was survival to hospital discharge. We utilized a mixed linear model to compare the levels of cytokines in survivors and non-survivors over time. We used multivariable logistic regression to assess the association between IL-6 levels and mortality.

RESULTS:

A total of 102 patients were analyzed. Non-survivors and patients with poor functional outcome had statistical significant higher IL-1Ra, IL-6, IL-8, and IL-10 levels (all p<0.001) at all time points (0, 12 and 24h) compared to survivors. Baseline IL-6 levels were a good predictor of mortality (AUC=0.83 [95%CI: 0.75-0.92]). Baseline IL-6 levels were strongly associated with mortality in multivariable analysis (OR: 2.58 [95%CI: 1.93-3.45], p<0.001) but were not associated with neurological outcome in multivariable analysis (OR: 1.33 [95%CI: 0.62-2.86], p=0.47).

CONCLUSION:

Early inflammatory markers, especially IL-6, are higher in patients with a poor outcome after OHCA. IL-6 remained associated with mortality, but not functional outcome, in multivariable analysis adjusting for patient and event characteristics.

KEYWORDS:

Cardiac arrest; Cytokines; Inflammation; Interleukin 6; Mortality; Post-cardiac arrest

[Indexed for MEDLINE]

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