• Mary Ann Peberdy, Lars W Andersen, Antonio Abbate, Leroy R Thacker, David Gaieski, Benjamin S Abella, Anne V Grossestreuer, Jon C Rittenberger, John Clore, Joseph Ornato, Michael N Cocchi, Clifton Callaway, Michael Donnino, and National Post Arrest Research Consortium (NPARC) Investigators.
• Department of Internal Medicine and Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: mpeberdy@aol.com.
• Resuscitation. 2016 Jun 1; 103: 117-124.

AimThe 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.MethodsThis 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.ResultsA 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).ConclusionEarly 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.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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