Journal
RESUSCITATION
Volume 98, Issue -, Pages 1-8Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.resuscitation.2015.10.009
Keywords
Cardiac arrest; Hypothermia; Inflammation; Interleukins; Prognosis; Mortality
Categories
Funding
- Swedish Heart Lung Foundation
- Thelma Zoega Foundation
- TrygFonden, Denmark
- Arbetsmarknadens forsakringsaktiebolag (AFA)-insurance Foundation
- Swedish Research Council
- Regional research support, Region Skane
- Governmental funding of clinical research within the Swedish NHS (National Health Services)
- Krapperup Foundation
- Thure Carlsson Foundation
- Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research
- Skane University Hospital
- Sweden
- European Clinical Research Infrastructures Network
- EU Interreg IV A programme
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Aim: Post-cardiac arrest syndrome (PCAS) is characterized by systemic inflammation, however data on the prognostic value of inflammatory markers is sparse. We sought to investigate the importance of systemic inflammation, assessed by interleukin-6 (IL-6) in comatose survivors of out-of-hospital cardiac arrest. Methods: A total of 682 patients enrolled in the Target Temperature Management (TTM) trial, surviving >24 h with available IL-6 data were included. IL-6 was measured on days 1, 2 and 3 after return of spontaneous circulation. Severity of PCAS was assessed daily by the Sequential Organ Failure Assessment score. Survival status was recorded at 30 days. Results: High levels of IL-6 at day 1-3 (all p < 0.0001) were independently associated with severity of PCAS with no interaction of target temperature (all p = NS). IL-6 levels did not differ between temperature groups (pinteraction = 0.99). IL-6 levels at day 2 (p < 0.0001) and day 3 (p < 0.0001) were associated with crude mortality. Adjusted Cox proportional-hazards analysis showed that a two-fold increase of IL-6 levels at day 2 (HR = 1.15 (95% CI: 1.07-1.23), p = 0.0002) and day 3 (HR = 1.18 (95% CI: 1.09-1.27), p < 0.0001) were associated with mortality. IL-6 levels at day 3 had the highest discriminative value in predicting mortality (AUC = 0.66). IL-6 did not significantly improve 30-day mortality prediction compared to traditional prognostic factors (p = 0.08). Conclusions: In patients surviving >24 h following cardiac arrest, IL-6 levels were significantly elevated and associated with severity of PCAS with no significant influence of target temperature. High IL-6 levels were associated with increased mortality. Measuring levels of IL-6 did not provide incremental prognostic value. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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