• Kate F Kernan, Rachel P Berger, ClarkRobert S BRSBCritical Care Medicine UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, United States; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Children's Neuroscie, Scott WatsonRRDepartment of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States., Derek C Angus, Ashok Panigrahy, Clifton W Callaway, Michael J Bell, Patrick M Kochanek, Ericka L Fink, and Dennis W Simon.
• Critical Care Medicine UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, United States; Children's Neuroscience Institute, University of Pittsburgh, Pittsburgh, PA, United States.
• Resuscitation. 2021 Oct 1; 167: 307-316.

AimWe hypothesized that serum biomarkers of inflammation including chemokine, cytokine, pituitary hormones, and growth factors following cardiac arrest in children would independently associate with 6-month neurologic outcome.MethodsIn this prospective observational single center study of children with in-hospital and out-of-hospital cardiac arrest surviving to intensive care unit admission, serum was obtained twice per 24 h period between 0 h and 96 h and once at approximately 196 h post-cardiac arrest. Inflammatory mediators, hormones, and growth factors were analyzed by Luminex Multiplex Bead Immunoassay. We recorded demographics, resuscitation characteristics, and Pediatric Cerebral Performance Category (PCPC) at 6 months. We analyzed the association and area under the curve (AUC) of biomarker levels with favorable (PCPC 1-3) or unfavorable (PCPC 4-6, or >1 increase from baseline) outcome.ResultsForty-two children (50% female; median age of 2.5 [IQR: 0.4-10.2]) were enrolled and 18 (42%) died prior to 6-month follow up. Receiver operator curves for initial levels of ciliary neurotrophic factor (CNTF, AUC 0.84, 95% CI 0.73-0.96, p < 0.001) and interleukin (IL-17, AUC 0.84, 95% CI 0.73-0.97, p < 0.001) best classified favorable versus unfavorable 6-month outcome. In multivariable analysis, initial levels of CNTF and IL-17 remained associated with 6-month PCPC. Peak levels of interferon-γ-inducible protein 10 (IP-10), CNTF, and hepatocyte growth factor (HGF) were also independently associated with outcome.ConclusionIncreased serum concentrations of CNTF and IL-17 associated with unfavorable 6-month neurologic outcome of children surviving cardiac arrest. Further investigation of the prognostic utility and roles of CNTF and IL-17 in the pathophysiology of post-cardiac arrest syndrome are warranted. This project is registered with clinicaltrials.gov (NCT00797680) as "Duration of Hypothermia for Neuroprotection after Pediatric Cardiac Arrest: A Randomized, Controlled Trial".Copyright © 2021. Published by Elsevier B.V.

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