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

Academic Article

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.
  • Authors

    Published In

  • Resuscitation  Journal
  • Keywords

  • Cardiac arrest, Cytokines, Inflammation, Interleukin 6, Mortality, Post-cardiac arrest, Adult, Aged, Cardiopulmonary Resuscitation, Female, Hospital Mortality, Humans, Inflammation Mediators, Interleukins, Logistic Models, Male, Middle Aged, Out-of-Hospital Cardiac Arrest, Predictive Value of Tests, Prospective Studies, Tumor Necrosis Factor-alpha
  • Digital Object Identifier (doi)

    Author List

  • Peberdy MA; Andersen LW; Abbate A; Thacker LR; Gaieski D; Abella BS; Grossestreuer AV; Rittenberger JC; Clore J; Ornato J
  • Start Page

  • 117
  • End Page

  • 124
  • Volume

  • 103