Abstract
Background
The post-cardiac arrest syndrome (PCAS) after out-of-hospital cardiac arrest (OHCA) is characterized by a series of pathological events, including inflammation. In the randomized “STERoid for OHCA” (STEROHCA) trial, prehospital high-dose glucocorticoid decreased interleukin (IL) 6 and C-reactive protein levels following resuscitated OHCA. The aim of this predefined sub-study was to assess the inflammatory response the first three days of admission.
Methods
The STEROHCA trial enrolled 137 OHCA patients randomized to either a single prehospital injection of methylprednisolone 250 mg or placebo. Inflammatory markers, including pro- and anti-inflammatory cytokines, were analyzed in plasma samples, from 0-, 24-, 48-, and 72 h post-admission. Mixed-model analyses were applied using log-transformed data to assess group differences.
Results
The 137 patients included in this sub-study had a median age of 67 years (57 to 74), and the 180-day survival rates were 75% (n = 51/68) and 64% (n = 44/69) in the glucocorticoid and placebo group, respectively. A total of 130 (95%) patients had at least one plasma sample available. The anti-inflammatory cytokine IL-10 was increased at hospital admission in the glucocorticoid group (ratio 2.74 (1.49–5.05), p = 0.006), but the intervention showed the strongest effect after 24 h, decreasing pro-inflammatory levels of IL-6 (ratio 0.06 (0.03–0.10), p < 0.001), IL-8 (ratio 0.53 (0.38–0.75), p < 0.001), macrophage chemokine protein-1 (MCP-1, ratio 0.02 (0.13–0.31), p < 0.001), macrophage inflammatory protein-1-beta (MIP-1b, ratio 0.28 (0.18–0.45), p < 0.001), and tumor necrosis factor-α (TNF-α, ratio 0.6 (0.4–0.8), p = 0.01).
Conclusion
Administering high-dose glucocorticoid treatment promptly after resuscitation from OHCA influenced the inflammatory response with a reduction in several systemic proinflammatory cytokines after 24 h.
The post-cardiac arrest syndrome (PCAS) after out-of-hospital cardiac arrest (OHCA) is characterized by a series of pathological events, including inflammation. In the randomized “STERoid for OHCA” (STEROHCA) trial, prehospital high-dose glucocorticoid decreased interleukin (IL) 6 and C-reactive protein levels following resuscitated OHCA. The aim of this predefined sub-study was to assess the inflammatory response the first three days of admission.
Methods
The STEROHCA trial enrolled 137 OHCA patients randomized to either a single prehospital injection of methylprednisolone 250 mg or placebo. Inflammatory markers, including pro- and anti-inflammatory cytokines, were analyzed in plasma samples, from 0-, 24-, 48-, and 72 h post-admission. Mixed-model analyses were applied using log-transformed data to assess group differences.
Results
The 137 patients included in this sub-study had a median age of 67 years (57 to 74), and the 180-day survival rates were 75% (n = 51/68) and 64% (n = 44/69) in the glucocorticoid and placebo group, respectively. A total of 130 (95%) patients had at least one plasma sample available. The anti-inflammatory cytokine IL-10 was increased at hospital admission in the glucocorticoid group (ratio 2.74 (1.49–5.05), p = 0.006), but the intervention showed the strongest effect after 24 h, decreasing pro-inflammatory levels of IL-6 (ratio 0.06 (0.03–0.10), p < 0.001), IL-8 (ratio 0.53 (0.38–0.75), p < 0.001), macrophage chemokine protein-1 (MCP-1, ratio 0.02 (0.13–0.31), p < 0.001), macrophage inflammatory protein-1-beta (MIP-1b, ratio 0.28 (0.18–0.45), p < 0.001), and tumor necrosis factor-α (TNF-α, ratio 0.6 (0.4–0.8), p = 0.01).
Conclusion
Administering high-dose glucocorticoid treatment promptly after resuscitation from OHCA influenced the inflammatory response with a reduction in several systemic proinflammatory cytokines after 24 h.
| Originalsprog | Engelsk |
|---|---|
| Artikelnummer | 110340 |
| Tidsskrift | Resuscitation |
| Vol/bind | 202 |
| Antal sider | 11 |
| ISSN | 0300-9572 |
| DOI | |
| Status | Udgivet - 2024 |
Bibliografisk note
Funding Information:We extend our sincere gratitude to all prehospital physicians and trial guardians whose contributions were essential to the inclusion process. Special recognition goes to the daily leaders of the physician-manned critical care units: S\u00F8ren Loumann Nielsen, Steen M\u00F8iniche, Henrik Alstr\u00F8m, Lars Dahlgaard Hove, and S\u00F8ren Hestad. We also express our appreciation to the entire personnel at the Department of Cardiology, especially the Cardiac Intensive Care Unit at Rigshospitalet, the Intensive Care Unit at Gentofte Hospital, and the Emergency Medical Services of the Capital Region of Denmark, Copenhagen. Additionally, we would like to thank Mie Christa Larsen, \u00C1slaug Karlsd\u00F3ttir, and Lesli Hingstrup Larsen from the Clinical Research Unit at Rigshospitalet; Ann Kristine Thorsteinsson, Tung Thanh Phan, and Mette Krefeld Bentzen from the Department of Biochemistry at Rigshospitalet; Pia Hornbeck from the Medical/Steno Aarhus Research Lab, Aarhus University; and the staff at the pharmacy of the Capital Region of Denmark, Copenhagen, for their invaluable contributions.
Funding Information:
The study received funding from the Novo Nordisk Foundation (NNF20OC0064043) and the Research Foundation of Rigshospitalet (E-22652-04). The funders were no involvement in the study design, data collection, analysis, interpretation, or manuscript writing.
Publisher Copyright:
© 2024 The Author(s)