title: Admission interleukin-6 is associated with post resuscitation organ dysfunction and predicts long-term neurological outcome after out-of-hospital ventricular fibrillation.
abstract: OBJECTIVE
  To study plasma concentrations of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP) and S-100B during intensive care after out-of-hospital cardiac arrest from ventricular fibrillation (OHCA-VF), and their associations with the duration of ischemia, organ dysfunction and long-term neurological outcome.
  
  
  METHODS
  A 12-month prospective observational multicentre study was conducted in 21 Finnish intensive care units in 2011. IL-6, hs-CRP and S-100B were measured at 0-6 h, 24 h, 48 h and 96 h after ICU admission. Associations with the time to return of spontaneous circulation (ROSC), sequential organ failure assessment (SOFA) scores divided into tertiles and 12-month cerebral performance category (CPC) were tested.
  
  
  RESULTS
  Of 186 OHCA-VF patients included in the study, 110 (59.1%) patients survived with good neurological outcome (CPC 1-2) 12 months after cardiac arrest. Admission plasma concentrations of IL-6 but not hs-CRP were higher with prolonged time to ROSC (p<0.001, 0.203, respectively), in patients with subsequent higher SOFA scores (p<0.001, 0.069) and poor long-term neurological outcome (CPC 3-5) (p<0.001, 0.315). S-100B concentrations over time were higher in patients with CPC of 3-5 (p<0.001). The area under the curve for prediction of poor 12-month outcome for admission levels was 0.711 IL-6, 0.663 for S-100B and 0.534 for hs-CRP. With multivariate logistic regression analysis only admission IL-6 (p=0.046, OR 1.006, 95% CI 1.000-1.011/ng/L) was an independent predictor of poor neurological outcome.
  
  
  CONCLUSIONS
  Admission high IL-6, but not hs-CRP or S-100B, is associated with extra-cerebral organ dysfunction and along with age and time to ROSC are independent predictors for 12-month poor neurologic outcome (CPC 3-5).
authors.affiliation: Intensive Care Units, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, Helsinki, Finland. Electronic address: jukka.vaahersalo@hus.fi.
authors.forename: Jukka
authors.initials: J
authors.lastname: Vaahersalo
authors.affiliation: Intensive Care Units, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Markus B
authors.initials: MB
authors.lastname: Skrifvars
authors.affiliation: Department of Clinical Chemistry, School Of Medicine, University of Eastern Finland and Eastern Finland Laboratory Centre, Kuopio, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Pulkki
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Stridsberg
authors.affiliation: Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Institute for Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Helge
authors.initials: H
authors.lastname: Røsjø
authors.affiliation: Department of Anaesthesiology, South-Carelia Hospital, Lappeenranta, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Hovilehto
authors.affiliation: Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Marjaana
authors.initials: M
authors.lastname: Tiainen
authors.affiliation: Intensive Care Units, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Tero
authors.initials: T
authors.lastname: Varpula
authors.affiliation: Intensive Care Units, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.affiliation: Division of Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Esko
authors.initials: E
authors.lastname: Ruokonen
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D005387:Finland; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000401:mortality; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000401:mortality / Q000628:therapy; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D009418:S100 Proteins / Q000032:analysis; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000097:blood* / Q000401:mortality / Q000628:therapy
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D009418:S100 Proteins; D002097:C-Reactive Protein
keywords: Cardiac arrest; High-sensitive C-reactive protein; Inflammation; Interleukin-6; Long-term neurological outcome; S-100B