Abstract 46: Tnf-α and Il-6 Levels Are Associated With Illness Severity and Outcome Following Cardiac Arrest
Introduction: Post-cardiac arrest illness is likened to sepsis given inflammatory cytokine elevations. This study tested if cytokine levels after cardiac arrest relate to illness severity.
Methods: Serum and plasma samples were obtained from subjects at hospital arrival, 6, 12, 24, 48, and 72 hours after cardiac arrest. Cytokines were measured using a 30-marker Luminex assay. Four categories of post-cardiac arrest illness severity were defined by neurological examination and sequential organ failure assessment (SOFA) score on presentation: 1) awake, 2) coma (not following commands but intact brainstem responses) + mild cardiopulmonary dysfunction (SOFA cardiac + respiratory score <4), 3) coma + moderate-severe cardiopulmonary dysfunction (SOFA cardiac + respiratory score >=4) , and 4) coma without brainstem reflexes. Transformations of data were conducted as needed to normalize data. Linear mixed models were used to analyze cytokine levels and their correlation with category of arrest, survival and neurologic outcome. Category 1 subjects were used as the referent.
Results: TNFα, IL-6, IL-8, IL-10, VEGF, and MCP-1, were measured in 45 subjects. Mean age was 59 ±15 years, 29 (64%) were male, 26 (58%) OHCA, 23 (51%) experienced ventricular dysrhythmia as the primary rhythm of arrest, 23 (51%) survived, and 19 (42%) experienced a good outcome. There were 8 (18%) category 1, 15 (33%) category 2, 4 (9%) category 3, and 18 (40%) category 4 subjects. TNFα, IL-6, and IL-8 levels differed by category over time (p<0.05). However, IL-10, VEGF, and CMP-1 did not differ. TNF-α and IL-6 levels were lower in survivors than in non-survivors (p<0.05), while IL-8, IL-10, VEGF, and MCP-1 levels did not differ between survivors and non-survivors. TNFα and IL-6 levels were lower in subjects experiencing good outcome (p<0.05) while IL-8, IL-10, VEGF, and MCP-1 levels did not differ.
Discussion: Elevated TNFα and IL-6 levels are associated with post-cardiac arrest illness severity, survival and good outcome. Increased cytokine release is associated with post-cardiac arrest illness with significant cardiopulmonary dysfunction.
- © 2010 by American Heart Association, Inc.