title: Elevations of inflammatory markers PTX3 and sST2 after resuscitation from cardiac arrest are associated with multiple organ dysfunction syndrome and early death.
abstract: BACKGROUND
  A systemic inflammatory response is observed after cardiopulmonary resuscitation. We investigated two novel inflammatory markers, pentraxin 3 (PTX3) and soluble suppression of tumorigenicity 2 (sST2), in comparison with the classic high-sensitivity C-reactive protein (hsCRP), for prediction of early multiple organ dysfunction syndrome (MODS), early death, and long-term outcome after out-of-hospital cardiac arrest.
  
  
  METHODS
  PTX3, sST2, and hsCRP were assayed at ICU admission and 48 h later in 278 patients. MODS was defined as the 24 h non-neurological Sequential Organ Failure Assessment (SOFA) score ≥ 12. Intensive care unit (ICU) death and 12-month Cerebral Performance Category (CPC) were evaluated.
  
  
  RESULTS
  In total, 82% of patients survived to ICU discharge and 48% had favorable neurological outcome at 1 year (CPC 1 or 2). At ICU admission, median plasma levels of hsCRP (2.8 mg/L) were normal, while levels of PTX3 (19.1 ng/mL) and sST2 (117 ng/mL) were markedly elevated. PTX3 and sST2 were higher in patients who developed MODS (p<0.0001). Admission levels of PTX3 and sST2 were also higher in patients who died in ICU and in those with an unfavorable 12-month neurological outcome (p<0.01). Admission levels of PTX3 and sST2 were independently associated with subsequent MODS [OR: 1.717 (1.221-2.414) and 1.340, (1.001-1.792), respectively] and with ICU death [OR: 1.536 (1.078-2.187) and 1.452 (1.064-1.981), respectively]. At 48 h, only sST2 and hsCRP were independently associated with ICU death.
  
  
  CONCLUSIONS
  Higher plasma levels of PTX3 and sST2, but not of hsCRP, at ICU admission were associated with higher risk of MODS and early death.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ristagno
authors.forename: Tero
authors.initials: T
authors.lastname: Varpula
authors.forename: Serge
authors.initials: S
authors.lastname: Masson
authors.forename: Marta
authors.initials: M
authors.lastname: Greco
authors.forename: Barbara
authors.initials: B
authors.lastname: Bottazzi
authors.forename: Valentina
authors.initials: V
authors.lastname: Milani
authors.forename: Aneta
authors.initials: A
authors.lastname: Aleksova
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.forename: Roberto
authors.initials: R
authors.lastname: Assandri
authors.forename: Marjaana
authors.initials: M
authors.lastname: Tiainen
authors.forename: Jukka
authors.initials: J
authors.lastname: Vaahersalo
authors.forename: Jouni
authors.initials: J
authors.lastname: Kurola
authors.forename: Simona
authors.initials: S
authors.lastname: Barlera
authors.forename: Alessandro
authors.initials: A
authors.lastname: Montanelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.forename: Stepani
authors.initials: S
authors.lastname: Bendel
authors.forename: Markus B
authors.initials: MB
authors.lastname: Skrifvars
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000401:mortality*; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000401:mortality*; D017481:Receptors, Somatostatin / Q000097:blood*; D000683:Serum Amyloid P-Component / Q000032:analysis*; D000099153:Pentraxins
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D017481:Receptors, Somatostatin; D000683:Serum Amyloid P-Component; D000099153:Pentraxins; C093733:somatostatin receptor 2