title: Infectious complications after out-of-hospital cardiac arrest-A comparison between two target temperatures.
abstract: It has been suggested that target temperature management (TTM) increases the probability of infectious complications after cardiac arrest. We aimed to compare the incidence of pneumonia, severe sepsis and septic shock after out-of-hospital cardiac arrest (OHCA) in patients with two target temperatures and to describe changes in biomarkers and possible mortality associated with these infectious complications.
  
  
  
  Post-hoc analysis of the TTM-trial which randomized patients resuscitated from OHCA to a target temperature of 33°C or 36°C. Prospective data on infectious complications were recorded daily during the ICU-stay. Pneumonia, severe sepsis and septic shock were considered infectious complications. Procalcitonin (PCT) and C-reactive-protein (CRP) levels were measured at 24h, 48h and 72h after cardiac arrest.
  
  
  
  There were 939 patients in the modified intention-to-treat population. Five-hundred patients (53%) developed pneumonia, severe sepsis or septic shock which was associated with mortality in multivariate analysis (Hazard ratio [HR] 1.39; 95%CI 1.13-1.70; p=0.001). There was no statistically significant difference in the incidence of infectious complications between temperature groups (sub-distribution hazard ratio [SHR] 0.88; 95%CI 0.75-1.03; p=0.12). PCT and CRP were significantly higher for patients with infections at all times (p<0.001), but there was considerable overlap.
  
  
  
  Patients who develop pneumonia, severe sepsis or septic shock after OHCA might have an increased mortality. A target temperature of 33°C after OHCA was not associated with an increased risk of infectious complications compared to a target temperature of 36°C. PCT and CRP are of limited value for diagnosing infectious complications after cardiac arrest.
authors.affiliation: Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Getingevägen, 22185 Lund, Sweden. Electronic address: Josef.dankiewicz@med.lu.se.
authors.forename: Josef
authors.initials: J
authors.lastname: Dankiewicz
authors.affiliation: Department of Clinical Sciences, Lund University, Getingevägen, 22185 Lund, Sweden; Department of Anaesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Nielsen
authors.affiliation: Department of Clinical Sciences, Lund University, Getingevägen, 22185 Lund, Sweden; Division of Infection Medicine, Lund University Hospital, Lund, Sweden.
authors.forename: Adam
authors.initials: A
authors.lastname: Linder
authors.affiliation: Department of Intensive Care, Leeuwarden Hospital, Leeuwarden, The Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Kuiper
authors.affiliation: Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Wise
authors.affiliation: Department of Clinical Sciences, Lund University, Getingevägen, 22185 Lund, Sweden; Department of Neurology, Skåne University Hospital, Lund, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Cronberg
authors.affiliation: Department of Clinical Sciences, Lund University, Getingevägen, 22185 Lund, Sweden; Department of Cardiology, Skåne University Hospital, Lund Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
authors.affiliation: Department of Intensive Care, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Gasche
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Harmon
authors.affiliation: Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.affiliation: Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
authors.affiliation: Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Kjaergaard
authors.affiliation: Department of Intensive Care, Santa Maria degli Ángeli, Pordenone, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Pellis
authors.affiliation: Department of Anesthesiology and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg.
authors.forename: Pascal
authors.initials: P
authors.lastname: Stammet
authors.affiliation: Department of Clinical Sciences, Lund University, Getingevägen, 22185 Lund, Sweden; Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Undén
authors.affiliation: Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Wanscher
authors.affiliation: Copenhagen Trial Unit, Centre of Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jørn
authors.initials: J
authors.lastname: Wetterslev
authors.affiliation: Department of Intensive Care, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Anders
authors.initials: A
authors.lastname: Åneman
authors.affiliation: R&D Centre Skåne, Skåne University Hospital, Lund, Sweden.
authors.forename: Susann
authors.initials: S
authors.lastname: Ullén
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Juffermans
authors.affiliation: Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Getingevägen, 22185 Lund, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Friberg
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D001831:Body Temperature; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy; D011014:Pneumonia / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D018805:Sepsis / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D012772:Shock, Septic / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002116:Calcitonin; D002097:C-Reactive Protein
keywords: Hypothermia; Infection; Out-of-hospital cardiac arrest; Procalcitonin; c-Reactive protein