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

• Published in: Resuscitation Vol. 103; pp. 117 - 124
• Main Authors: Peberdy, Mary Ann, Andersen, Lars W, Abbate, Antonio, Thacker, Leroy R, Gaieski, David, Abella, Benjamin S, Grossestreuer, Anne V, Rittenberger, Jon C, Clore, John, Ornato, Joseph, Cocchi, Michael N, Callaway, Clifton, Donnino, Michael
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-06-2016
• Subjects: Adult; Aged; Cardiac arrest; Cardiopulmonary Resuscitation; Cytokines; Emergency; Female; Hospital Mortality; Humans; Inflammation; Inflammation Mediators - blood; Interleukin 6; Interleukins - blood; Logistic Models; Male; Middle Aged; Mortality; Out-of-Hospital Cardiac Arrest - blood; Out-of-Hospital Cardiac Arrest - mortality; Post-cardiac arrest; Predictive Value of Tests; Prospective Studies; Tumor Necrosis Factor-alpha - blood; Interleukin 6; Post-cardiac arrest; Inflammation; Cytokines; Mortality; Cardiac arrest
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2016.01.006

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 24 h 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 24 h) 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.