Abstract 15518: Plasma Levels of Interleukin-1beta (IL-1beta) And IL-1 Receptor Antagonist Predict Mortality in Cardiac Arrest Patients Undergoing Therapeutic Hypothermia
Background: Return of spontaneous circulation (ROSC) after cardiac arrest (CA) is associated with systemic ischemia-reperfusion injury and a severe inflammatory response similar to sepsis. IL-1 is a powerful inducer of the innate immune response and induces hundreds of secondary inflammatory mediators and may be associated with severity of inflammation and outcomes after CA.
Hypothesis: Systemic measures of IL-1 activity (plasma IL-1β and IL-1 receptor antagonist [IL-1Ra], a surrogate of IL-1 activity) are predictive of outcome in patients (pts) with ROSC after CA undergoing therapeutic hypothermia (TH).
Methods: Blood samples were taken upon arrival to the hospital in 111 consecutive adult pts with ROSC after CA in the 4 center Characterization of Mitochondrial Injury after Cardiac Arrest (COMICA) study evaluating markers of inflammation and injury after CA. Plasma levels of each biomarker were used as continuous variable in the binary logistic analysis and the receiver operating curve. Furthermore, patients were divided in 2 groups according to biomarker levels (below and above median).
Results: Survival was 47%. Plasma IL-1β levels obtained 207 min (110-327) after ROSC were below the detection limit for the ELISA assay used (7 pg/ml) in 66 pts (59%), whereas pts with detectable levels were significantly more likely to die than those with undetectable levels (69% vs 45%, p=0.020). Plasma IL-1Ra levels were elevated in 100% pts and predicted death with a receiving operating curve area-under-the-curve value of 0.735 (p<0.001). Pts with IL-1Ra above the median had significantly greater mortality (Figure).
Conclusions: Early plasma markers of IL-1 activity are predictors of mortality in pts with ROSC after CA undergoing TH. Future studies are needed to determine causation with outcome and potential benefit of IL-1 blocking agents as a treatment strategy post CA.
- Ischemia reperfusion
- Cardiac arrest
- Mitochondrial energetics, heart failure, arrhythmias
- © 2013 by American Heart Association, Inc.