title: Inflammatory markers following resuscitation from out-of-hospital cardiac arrest-A prospective multicenter observational study.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.affiliation: Department of Internal Medicine and Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: mpeberdy@aol.com.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Peberdy
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars W
authors.initials: LW
authors.lastname: Andersen
authors.affiliation: Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Abbate
authors.affiliation: Department of Nursing, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Leroy R
authors.initials: LR
authors.lastname: Thacker
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Gaieski
authors.affiliation: Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.affiliation: Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Anne V
authors.initials: AV
authors.lastname: Grossestreuer
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Rittenberger
authors.affiliation: Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Clore
authors.affiliation: Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ornato
authors.affiliation: 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.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cocchi
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Clifton
authors.initials: C
authors.lastname: Callaway
authors.affiliation: 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.
authors.forename: Michael
authors.initials: M
authors.lastname: Donnino
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007378:Interleukins / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D018836:Inflammation Mediators; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha
keywords: Cardiac arrest; Cytokines; Inflammation; Interleukin 6; Mortality; Post-cardiac arrest