Abstract P69: Categorization of Post-cardiac Arrest Patients by Coma and Cardiopulmonary Dysfunction Predicts Inflammation and Outcome
Background: After resuscitation from cardiac arrest, patients are physiologically heterogeneous in terms of their patterns of neurologic function and cardiopulmonary dysfunction, which may permit tailoring of therapy.
Hypothesis: Neurologic and cardiopulmonary dysfunction after cardiac arrest will identify categories of subjects with distinct inflammatory and neuronal injury marker changes.
Methods: We measured Neuron Specific Enolase (NSE), interleukin (IL) 6, IL8 and IL10 in subjects at 0, 6, 12, 24, 48, 72 hours after cardiac arrest using Luminex and ELISA. The subject’s initial Sequential Organ Failure Assessment (SOFA) and Four Score (FS) coma scale were determined upon ICU arrival. The cardiovascular and pulmonary scales of the SOFA score were then summed (CP). Other sub-scales were affected by premorbid conditions. Subjects were categorized using FS<8 or ≥9 and CP<4 or ≥5. The effect of both time and category of arrest was evaluated using generalized estimating equation (GEE).
Results: The CP-FS category of the 29 subjects in this study is shown in the Figure⇓. All subjects in category I (awake, CP low) survived, 53% in category II (comatose, CP low) survived and 30% in category III (CP high) survived. Category III was associated with increased IL6 and IL10 (p=0.012 and p<0.01, respectively). Neither time nor category correlated with IL8 or NSE response.
Conclusions: Injury category predicts outcome and markers of inflammation in the post-cardiac arrest population. This may be useful for identifying subgroups of patients with more homogeneous physiology. Inflammatory response correlates with organ failure.