Soluble selectins and the systemic inflammatory response syndrome after successful cardiopulmonary resuscitation.
OBJECTIVE
Elevated cytokine levels have been reported after ischemia/reperfusion injury and might cause a systemic inflammatory response syndrome (SIRS) after successful cardiopulmonary resuscitation (CPR). It is unknown whether patients with SIRS after CPR exhibit higher levels of soluble adhesion molecules than patients without SIRS and whether SIRS or elevation of adhesion molecules is associated with outcome after CPR. We analyzed the relationships among various CPR-related variables, plasma levels of E- and P-selectin, the occurrence of SIRS after CPR, and the development of sepsis and outcome.


METHODS
Prospective, controlled study.


METHODS
Intensive care unit at a university hospital.


METHODS
A total of 25 patients on the second day after successful CPR and 7 non-critically ill control patients.


METHODS
Blood sampling for determination of plasma levels of soluble (s) E- and P-selectin.


RESULTS
SIRS was a frequent finding after CPR (66% of all patients) unrelated to time until return of spontaneous circulation (SIRS, 17+/-13 mins; no SIRS, 19+/-16 mins; p = .761), epinephrine dose (SIRS, 4+/-5 mg; no SIRS, 5+/-6 mg; p = .906), or serum lactate level after CPR (SIRS, 8.6+/-2.6 mmol/L; no SIRS, 8.7+/-4.0 mmol/L; p = .174). sP-selectin levels were higher in patients with SIRS (291.7+/-227.4 ng/mL) compared with patients without SIRS (113.4+/-88.4 ng/mL; p = .018) or with non-critically ill patients (116.9+/-33.4 ng/mL; p = .031). Compared with non-critically ill control patients (42.8+/-19.4 ng/mL), sE-selectin levels were higher in patients with (96.2+/-47.3 ng/mL; p = .023) and without SIRS (99.5+/-65.7 ng/mL; p = .030). sP-selectin was higher in patients developing sepsis within 1 wk after CPR (n = 9) than in patients without sepsis (350.2+/-233.4 ng/mL vs. 158.5+/-157.8 ng/mL; p = .022) and sE-selectin levels were higher in nonsurvivors (n = 5) than in survivors (144.2+/-62.4 ng/mL vs. 85.7+/-45.3 ng/mL; p = .025) whereas SIRS was unrelated to the development of sepsis (p = .4) and unrelated to survival (p = .4).


CONCLUSIONS
SIRS is an unspecific finding after CPR with only minor impact on outcome. Determination of sP- and sE-selectin early after CPR might help to identify patients at a high risk for sepsis or for an adverse outcome, respectively.
Intensive Care Unit of the Department of Cardiology, University of Vienna, Austria.
A
A
Geppert
G
G
Zorn
G D
GD
Karth
M
M
Haumer
M
M
Gwechenberger
J
J
Koller-Strametz
G
G
Heinz
K
K
Huber
P
P
Siostrzonek
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D019040:E-Selectin / Q000097:blood*; D006801:Humans; D007362:Intensive Care Units; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D019007:P-Selectin / Q000097:blood*; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000209:etiology*; D016896:Treatment Outcome
D019040:E-Selectin; D007773:Lactates; D019007:P-Selectin