Predictive value of interleukin-6 in post-cardiac arrest patients treated with targeted temperature management at 33 °C or 36 °C

TY - JOUR

T1 - Predictive value of interleukin-6 in post-cardiac arrest patients treated with targeted temperature management at 33 °C or 36 °C

AU - Bro-Jeppesen, John

AU - Kjaergaard, Jesper

AU - Stammet, Pascal

AU - Wise, Matthew P

AU - Hovdenes, Jan

AU - Åneman, Anders

AU - Horn, Janneke

AU - Devaux, Yvan

AU - Erlinge, David

AU - Gasche, Yvan

AU - Wanscher, Michael

AU - Cronberg, Tobias

AU - Friberg, Hans

AU - Wetterslev, Jørn

AU - Pellis, Tommaso

AU - Kuiper, Michael

AU - Nielsen, Niklas

AU - Hassager, Christian

AU - TTM-Trial Investigators

N1 - Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - 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.

AB - 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.

U2 - 10.1016/j.resuscitation.2015.10.009

DO - 10.1016/j.resuscitation.2015.10.009

M3 - Journal article

C2 - 26525271

SN - 0300-9572

VL - 98

SP - 1

EP - 8

JO - Resuscitation

JF - Resuscitation

ER -