Division of Intensive Care, Department of Anaesthesiology and Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Acta Anaesthesiol Scand. 2023 Oct;67(9):1273-1287. doi: 10.1111/aas.14291. Epub 2023 Jun 20.
Post-cardiac arrest syndrome that occurs in out-of-hospital cardiac arrest (OHCA) patients is characterized by inflammatory response. We conducted a scoping review of current evidence regarding several inflammatory markers' usefulness for assessment of patient outcome and illness severity. We also discuss the proposed underlying mechanisms leading to inflammatory response after OHCA.
We searched the MEDLINE, PubMed Central, Cochrane CENTRAL and Web of Science Core Collection databases with the following search terms: ("inflammation" OR "cytokines") AND "out-of-hospital cardiac arrest." Each inflammatory marker found was combined with "out-of-hospital cardiac arrest" using "AND" to find further relevant studies. We included original studies measuring inflammatory markers in adult OHCA patients that assessed their prognostic capabilities for mortality, neurological outcome, or organ failure severity.
Fifty-nine studies met the inclusion criteria, covering in total 65 different markers. Interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) were the most studied markers, and they were associated with poor outcomes in 13/15, 13/14 and 11/17 studies, respectively. Based on area under the receiver operating characteristic curve (AUC) value, the time point of best discriminatory capacity for poor outcome was ICU admission for IL-6 (median AUC 0.78, range 0.71-0.98) and day one after OHCA for PCT (median AUC 0.84, range 0.61-0.98). Seven studies reported AUCs for CRP (range 0.52-0.76) with no measurement time point being superior to others. The association of IL-6 and PCT with outcome appeared stronger in studies with more severely ill patients. Studies reported conflicting results regarding each marker's association with organ failure severity.
Inflammatory markers are potentially useful for early risk stratification after OHCA. PCT and IL-6 have moderate prognostic value during the first 24 h of the ICU stay. Predictive accuracy appears to be associated with the study overall event rate.
在院外心脏骤停（OHCA）患者中发生的心脏骤停后综合征的特征是炎症反应。我们对目前关于几种炎症标志物用于评估患者预后和疾病严重程度的证据进行了范围界定审查。我们还讨论了 OHCA 后导致炎症反应的潜在机制。
我们使用以下搜索词在 MEDLINE、PubMed Central、Cochrane CENTRAL 和 Web of Science Core Collection 数据库中进行了搜索：（“炎症”或“细胞因子”）和“院外心脏骤停”。使用“AND”将找到的每个炎症标志物与“院外心脏骤停”结合起来，以找到进一步的相关研究。我们纳入了测量成年 OHCA 患者炎症标志物的原始研究，这些标志物评估了其对死亡率、神经预后或器官衰竭严重程度的预后能力。
符合纳入标准的研究有 59 项，共涵盖了 65 种不同的标志物。白细胞介素 6（IL-6）、降钙素原（PCT）和 C 反应蛋白（CRP）是研究最多的标志物，分别有 13/15、13/14 和 11/17 项研究表明它们与不良预后相关。根据受试者工作特征曲线下面积（AUC）值，预测不良预后的最佳鉴别能力的时间点为 ICU 入院时的 IL-6（中位数 AUC 为 0.78，范围为 0.71-0.98）和 OHCA 后第一天的 PCT（中位数 AUC 为 0.84，范围为 0.61-0.98）。有 7 项研究报告了 CRP 的 AUC 值（范围为 0.52-0.76），但没有一个测量时间点优于其他时间点。在病情较重的患者中，IL-6 和 PCT 与预后的相关性似乎更强。关于每种标志物与器官衰竭严重程度的相关性，研究结果存在矛盾。
炎症标志物可能对 OHCA 后早期风险分层有用。PCT 和 IL-6 在 ICU 入住的前 24 小时内具有中等的预后价值。预测准确性似乎与研究的总体事件发生率有关。
