Mary Ann Peberdy1, Lars W Andersen2, Antonio Abbate3, Leroy R Thacker4, David Gaieski5, Benjamin S Abella6, Anne V Grossestreuer6, Jon C Rittenberger7, John Clore3, Joseph Ornato8, Michael N Cocchi9, Clifton Callaway7, Michael Donnino10. 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.
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 arrestpatients. 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: Michael W Donnino; Xiaowen Liu; Lars W Andersen; Jon C Rittenberger; Benjamin S Abella; David F Gaieski; Joseph P Ornato; Raúl J Gazmuri; Anne V Grossestreuer; Michael N Cocchi; Antonio Abbate; Amy Uber; John Clore; Mary Anne Peberdy; Clifton W Callaway Journal: Resuscitation Date: 2017-01-23 Impact factor: 5.262
Authors: Jerry P Nolan; Claudio Sandroni; Bernd W Böttiger; Alain Cariou; Tobias Cronberg; Hans Friberg; Cornelia Genbrugge; Kirstie Haywood; Gisela Lilja; Véronique R M Moulaert; Nikolaos Nikolaou; Theresa Mariero Olasveengen; Markus B Skrifvars; Fabio Taccone; Jasmeet Soar Journal: Intensive Care Med Date: 2021-03-25 Impact factor: 17.440
Authors: Kei Hayashida; Ryosuke Takegawa; Muhammad Shoaib; Tomoaki Aoki; Rishabh C Choudhary; Cyrus E Kuschner; Mitsuaki Nishikimi; Santiago J Miyara; Daniel M Rolston; Sara Guevara; Junhwan Kim; Koichiro Shinozaki; Ernesto P Molmenti; Lance B Becker Journal: J Transl Med Date: 2021-05-17 Impact factor: 5.531
Authors: Monique M Gardner; Matthew P Kirschen; Hector R Wong; Daniel J McKeone; E Scott Halstead; Jill M Thompson; Adam S Himebauch; Alexis A Topjian; Nadir Yehya Journal: Resuscitation Date: 2021-12-03 Impact factor: 5.262
Authors: Catherine Madurski; Jessica M Jarvis; Sue R Beers; Amy J Houtrow; Amy K Wagner; Anthony Fabio; Chunyan Wang; Craig M Smith; Lesley Doughty; Keri Janesko-Feldman; Pamela Rubin; Dorothy Pollon; Amery Treble-Barna; Patrick M Kochanek; Ericka L Fink Journal: Neurocrit Care Date: 2021-03-04 Impact factor: 3.532
Authors: Michael W Donnino; Lars W Andersen; Katherine M Berg; Maureen Chase; Robert Sherwin; Howard Smithline; Erin Carney; Long Ngo; Parth V Patel; Xiaowen Liu; Donald Cutlip; Peter Zimetbaum; Michael N Cocchi Journal: Crit Care Date: 2016-04-03 Impact factor: 9.097
Authors: Kate F Kernan; Rachel P Berger; Robert S B Clark; R Scott Watson; Derek C Angus; Ashok Panigrahy; Clifton W Callaway; Michael J Bell; Patrick M Kochanek; Ericka L Fink; Dennis W Simon Journal: Resuscitation Date: 2021-07-14 Impact factor: 5.262