interleukin-8 and Heart-Arrest

Predicting the neurological outcome after resuscitation and a return of spontaneous circulation of resuscitated patients still remains a difficult issue. Over the past decade numerous studies have been elaborated to provide the physician with tools to assess as early as possible the neurological outcome of patients with cardiac arrest and return of spontaneous circulation and to decide about further therapeutic management. We summarise the most important ones, giving special focus to three biochemical markers (neuron specific enolase, a protein soluble in 100% ammonium sulfate and interleukin-8), which, when combined with standard neuro-functional and imaging techniques, can serve as potent predictors of neurological outcome in these patients. Despite current limitations about the prognostic significance of these markers - their inferior sensitivity, the different cut-off levels used by several investigators and their variable unequal rise over time - they can give useful information about short and long-term neurological outcome. A comprehensive set of clinical, electrophysiological, biochemical and imaging measures, obtained in a uniform manner in a cohort of patients without limitations in care, could provide a more objective set of comprehensive prognostic indicators.

Topics: Biomarkers; Brain Ischemia; Cardiopulmonary Resuscitation; Heart Arrest; Humans; Interleukin-8; Phosphopyruvate Hydratase; S100 Proteins; Treatment Outcome

To evaluate the changes in inflammatory cytokines, such as interleukin (IL)-8 and IL-6, in the cerebrospinal fluid (CSF) and serum, and to identify any correlations with the neurological outcomes in patients resuscitated from cardiopulmonary arrest (CPA).. This study was designed as a prospective clinical trial. Thirteen patients, who were resuscitated from out-of-hospital CPA and survived for more than 48 h, were enrolled in this study. Arterial blood was taken from the patients at 48 h after the return of spontaneous circulation (ROSC) and CSF was taken by lumbar puncture at the same time.. In the CSF, the median levels of IL-8 and IL-6 in the patients resuscitated from CPA were significantly higher than those in the control subjects (1311 pg/ml vs 82 pg/ml, P<0.001; 2040 pg/ml vs 1 pg/ml, P<0.001, respectively). The Glasgow Outcome Scale (GOS) score evaluated at 6 months after the ROSC correlated significantly with the levels of IL-8 and IL-6. The cutoff values and sensitivity values with 100% specificity for the prediction of an unfavorable neurological outcome were 1423 pg/ml and 86% for IL-8, and 2708 pg/ml and 86% for IL-6, respectively.. We demonstrated the cutoff values of IL-8 and IL-6 in the CSF to predict the neurological outcome in the patients resuscitated from CPA. The excessive inflammatory cytokine reactions in the brain might therefore be related to the poor neurological outcome in patients with post-resuscitation encephalopathy.

Topics: Adult; Aged; Cardiopulmonary Resuscitation; Female; Glasgow Outcome Scale; Heart Arrest; Humans; Hypothermia, Induced; Interleukin-6; Interleukin-8; Male; Middle Aged; Outcome Assessment, Health Care; Prospective Studies; Recovery of Function; Sensitivity and Specificity

We investigated the immunoinflammatory profile of patients successfully resuscitated after cardiac arrest, representing a model of whole-body ischemia/reperfusion syndrome.. Plasma cytokine, endotoxin, and ex vivo cytokine production in whole-blood assays was assessed in 61, 35, and 11 patients, respectively. On admission, high levels of plasma interleukin (IL)-6, IL-8, IL-10, and soluble tumor necrosis factor (TNF) receptor type II could discriminate between survivors and nonsurvivors. Among nonsurvivors, the initial need for a vasopressor agent was associated with higher levels of IL-1 receptor antagonist, IL-10, and IL-6 on day 1. Plasma endotoxin was detected in 46% of the analyzed patients within the 2 first days. Endotoxin-induced TNF and IL-6 productions were dramatically impaired in these patients compared with healthy control subjects, whereas an unaltered production was observed with heat-killed Staphylococcus aureus. In contrast, IL-1 receptor antagonist productions were enhanced in these patients compared with healthy control subjects. The productions of T-cell-derived IL-10 and interferon-gamma were also impaired in these patients. Finally, using in vitro plasma exchange between healthy control subjects and patients, we demonstrated that the endotoxin-dependent hyporeactivity was an intrinsic property of patients' leukocytes and that an immunosuppressive activity was also present in their plasma.. Altogether, the high levels of circulating cytokines, the presence of endotoxin in plasma, and the dysregulated production of cytokines found in these patients recall the immunological profile found in patients with sepsis.

Topics: Aged; Antigens, CD; Cardiopulmonary Resuscitation; Cytokines; Endotoxins; Female; Glasgow Coma Scale; Heart Arrest; Humans; Interleukin 1 Receptor Antagonist Protein; Interleukin-10; Interleukin-6; Interleukin-8; Leukocytes; Male; Middle Aged; Plasma; Predictive Value of Tests; Prospective Studies; Receptors, Tumor Necrosis Factor; Receptors, Tumor Necrosis Factor, Type II; Reference Values; Reperfusion Injury; Sialoglycoproteins; Survival Rate; Systemic Inflammatory Response Syndrome; Treatment Outcome

To observe the effects of Dachengqi decoction on serum levels of mast cell tryptase, monocyte chemoattractant protein-1 (MCP-1) and interleukin-8 (IL-8) in rabbits with post-cardiac arrest syndrome (PCAS).. Thirty healthy male Japanese rabbits were randomly divided into three groups: sham-operation group, PCAS model group and Dachengqi decoction treatment group. The model of PCAS was established by asphyxia-induced cardiac arrest. Fifteen minutes after return of spontaneous circulation, Dachengqi decoction [15 g/(kg.d), bid] was given by intra-gastric administration in Dachengqi decoction treatment group. The indicators of organ function were evaluated 24, 48 and 72 hours after cardiac arrest. The serum levels of mast cell tryptase, MCP-1 and IL-8 were determined by ELISA.. Dachengqi decoction alleviated the dysfunction significantly in heart, brain, liver and kidney. Compared with the sham group, the serum levels of mast cell tryptase, MCP-1 and IL-8 increased significantly in PCAS group (P<0.01). Compared with the PCAS group, the serum levels of mast cell tryptase (at 6 hours), MCP-1 (at 6, 24 and 48 hours) and IL-8 (at 6 and 24 hours) decreased significantly in Dachengqi decoction treatment group (P<0.05 or P<0.01).. Dachengqi decoction can reduce the serum levels of mast cell tryptase, MCP-1 and IL-8 in rabbits with post-cardiac arrest syndrome.

Topics: Animals; Chemokine CCL2; Enzyme-Linked Immunosorbent Assay; Heart Arrest; Interleukin-8; Male; Phytotherapy; Plant Extracts; Rabbits; Random Allocation; Syndrome; Treatment Outcome; Tryptases

Ex vivo lung perfusion (EVLP) is a promising modality for the evaluation and treatment of marginal donor lungs. The optimal timing of EVLP initiation and the potential for rehabilitation of donor lungs with extended warm ischemic times is unknown. The present study compared the efficacy of different treatment strategies for uncontrolled non-heart-beating donor lungs.. Mature swine underwent hypoxic arrest, followed by 60 minutes of no-touch warm ischemia. The lungs were harvested and flushed with 4°C Perfadex. Three groups (n = 5/group) were stratified according to the preservation method: cold static preservation (CSP; 4 hours of 4°C storage), immediate EVLP (I-EVLP: 4 hours EVLP at 37°C), and delayed EVLP (D-EVLP; 4 hours of CSP followed by 4 hours of EVLP). The EVLP groups were perfused with Steen solution supplemented with heparin, methylprednisolone, cefazolin, and an adenosine 2A receptor agonist. The lungs then underwent allotransplantation and 4 hours of recipient reperfusion before allograft assessment for resultant ischemia-reperfusion injury.. The donor blood oxygenation (partial pressure of oxygen/fraction of inspired oxygen ratio) before death was not different between the groups. The oxygenation after transplantation was significantly greater in the D-EVLP group than in the I-EVLP or CSP groups. The mean airway pressure, pulmonary artery pressure, and expression of interleukin-8, interleukin-1β, and tumor necrosis factor-α were all significantly reduced in the D-EVLP group. Post-transplant oxygenation exceeded the acceptable clinical levels only in the D-EVLP group.. Uncontrolled non-heart-beating donor lungs with extended warm ischemia can be reconditioned for successful transplantation. The combination of CSP and EVLP in the D-EVLP group was necessary to obtain optimal post-transplant function. This finding, if confirmed clinically, will allow expanded use of nonheart-beating donor lungs.

Topics: Animals; Arterial Pressure; Citrates; Cold Ischemia; Cold Temperature; Disease Models, Animal; Female; Heart Arrest; Inflammation Mediators; Interleukin-1beta; Interleukin-8; Lung; Lung Transplantation; Male; Organ Preservation Solutions; Perfusion; Pulmonary Artery; Pulmonary Gas Exchange; Reperfusion Injury; Respiratory Function Tests; Sus scrofa; Time Factors; Tissue Donors; Tumor Necrosis Factor-alpha; Warm Ischemia

Cardiac surgery with cardiopulmonary bypass (CPB) elicits an inflammatory response. During and after cardiac surgery, we examined the pattern of cytokine release of interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-alpha, to investigate inflammatory response. We analyzed N-terminal pro brain-type natriuretic peptide (NT-proBNP) as a marker of ventricular function.. Consecutive patients (n = 58) undergoing elective cardiac surgery with extra-corporeal circulation were recruited into the study. Blood samples for analysis of the biochemical markers were taken at seven time points for cytokines and TNF, and three for Nt-proBNP.. All markers increased significantly after CPB. IL-6 and IL-8 levels were higher in men. IL-8 was related to a need for inotropic support. IL-6 was related to the time of CPB (P = 0.004), aortic clamping (P = 0.013), length of stay in intensive care unit (ICU) (P = 0.004) and mechanical ventilation for more than 12 h (P = 0.006). The levels of NT-proBNP were higher in cases of ventricular dysfunction (P = 0.003) and functional class III/IV (P = 0.001). The postoperative values were related to age (P < 0.05), creatinine values (P < 0.001), mechanical ventilation time (P < 0.001) and stay in the ICU (P = 0.001).. Our data indicate a relationship between cytokine levels and sex, time of CPB and aortic clamping, The increase of cytokines correlates with a need for inotropic support, mechanical ventilation and length of stay in ICU. We confirmed the predictive role, and its utility in the risk stratification of the NT-proBNP, and its importance in early diagnosis of postoperative ventricular dysfunction.

Topics: Age Factors; Aged; Biomarkers; Cardiac Surgical Procedures; Critical Care; Elective Surgical Procedures; Female; Heart Arrest; Humans; Inflammation; Interleukin-6; Interleukin-8; Length of Stay; Male; Natriuretic Peptide, Brain; Peptide Fragments; Respiration, Artificial; Tumor Necrosis Factor-alpha; Ventricular Function

Because of the shortage of suitable brain-dead donors, the use of non-heart-beating donor lungs has been investigated experimentally. However, no effective lung protection method has been developed. In this study, we preliminarily investigated the protective effect of partial liquid ventilation (PLV) on a non-heart-beating rabbit lung.. We used 20 male rabbits (mean weight, 3.7 kg) and divided them into 3 groups: the conventional ventilation (control) group, the PLV without cooling group, and the PLV with cooling group. After initially measuring donor cardiopulmonary function, we maintained hypotension at <50 mm Hg for 1 hour followed by 2-hour cardiac arrest. During this time, we used either conventional ventilation or PLV with or without cooling (4 degrees C) for ventilation, and we evaluated the changes in arterial blood gas analysis, pulmonary resistance and elastance, tissue interleukin-8 (IL-8) concentration, and histologic damage.. We found no significant difference in arterial oxygen concentration or in carbon dioxide tension among the 3 groups in the hypotensive phase. Pulmonary elastance increased after perfusion of preservation solution in the control group. However, we found no change in elastance in the PLV groups, which was less than that in the control group. Histologic evaluation after perfusion of preservation solution revealed that alveolar structure was damaged significantly less and cell infiltration was milder in the PLV groups than in the control group. Although IL-8 concentrations in the controls increased after cardiac arrest, IL-8 in the PLV groups remained at baseline concentrations during the study period.. In this experimental model of hypotension and cardiac arrest, PLV suppresses lung injury when compared with gas-controlled ventilation.

Topics: Airway Resistance; Animals; Blood Gas Analysis; Cytokines; Disease Models, Animal; Heart Arrest; Hypotension; Interleukin-8; Liquid Ventilation; Lung; Lung Transplantation; Male; Rabbits

A better understanding of lung tissue environment after circulatory arrest would allow more accurate cell culture models to study ischemia-reperfusion lung injury and facilitate retrieval of lungs from non-heart-beating donors.. To establish the time course of changes in pH and PO2 in lung tissue after circulatory arrest, 12 Sprague-Dawley rats were sacrificed. After sternotomy, pH and PO2 microelectrodes were inserted into the lungs and sealed by application of Focal Seal. Rats were maintained at normothermia (37 degrees C). Two groups of rats (n = 6 atelectatic, n = 6 room air-inflated) were followed for 4 hours after arrest, when lung tissue adenine nucleotide levels were measured by chromatography and cell death was quantified by trypan blue exclusion. Human umbilical vein endothelial cells underwent simulated ischemia and 6 hours of cold storage by replacement of culture medium with cold Perfadex. Interleukin (IL)-6 and IL-8 were measured in medium 21 hours later by enzyme-linked immunosorbent assay (ELISA).. In both groups of rats, lung [H+] increased linearly with time. In atelectatic lungs, PO2 fell precipitously, but in inflated lungs, PO2 decreased linearly for 60 to 75 minutes post-mortem and then became stable. After 4 hours at 37 degrees C, most parenchymal lung cells were dead in both groups. IL-6 and IL-8 levels increased significantly in medium of cultured endothelial cells subjected to cold storage without hypoxia.. In room-air-inflated lungs maintained at 37 degrees C, oxygen consumption continues for at least 1 hour after circulatory arrest. Warm atelectasis is poorly tolerated. Hypothermic storage can induce elaboration of cytokines by endothelial cells in the absence of hypoxia.

Topics: Animals; Cell Culture Techniques; Cell Hypoxia; Cell Survival; Chromatography, High Pressure Liquid; Circulatory Arrest, Deep Hypothermia Induced; Cytokines; Endothelial Cells; Heart Arrest; Hydrogen-Ion Concentration; Interleukin-6; Interleukin-8; Lung; Lung Transplantation; Models, Biological; Oxygen; Oxygen Consumption; Pulmonary Atelectasis; Rats; Rats, Sprague-Dawley; Reperfusion Injury; Umbilical Cord

Topics: Biomarkers; Cardiopulmonary Resuscitation; Critical Care; Female; Heart Arrest; Humans; Intensive Care Units; Interleukin-8; Male; Monitoring, Physiologic; Nervous System Diseases; Predictive Value of Tests; Prognosis; Sensitivity and Specificity

To compare S-100B and interleukin-8 serum values on scene/at admission and 12 hrs later with respect to neurologic long-term outcome 12 months after cardiac arrest and return of spontaneous circulation, as well as after severe traumatic brain injury.. Prospective comparative cohort study.. On scene; intensive care units of a university hospital.. Twenty patients with out-of-hospital cardiac arrest. Twenty patients with severe traumatic brain injury.. Therapy was adjusted to the standards of modern prehospital and intensive care management by physicians who were not involved in the study.. First median S-100B values of the cardiac arrest group (4.42 ng/mL) mounted as high as those of the traumatic brain injury group (4.11 ng/mL). Within 12 hrs, S-100B levels significantly decreased to 0.75 ng/mL in cardiac arrest patients and to 0.68 ng/mL in traumatic brain injury patients but remained significantly elevated compared with the controls (0.04 ng/mL). Interleukin-8 levels of the cardiac arrest patients on scene (30.33 pg/mL) were clearly elevated above normal (12.60 pg/mL) and increased significantly to 101.40 pg/mL after 12 hrs. They showed no significant difference compared with those of the traumatic brain injury patients (78.75 pg/mL and 96.00 pg/mL, respectively). Multivariate Cox regression analysis in cardiac arrest patients identified only the S-100B level measured 12 hrs after study entry as an independent predictor for unfavorable neurologic outcome according to the Glasgow Outcome Scale score. In contrast, S-100B as well as interleukin-8 levels quantified 12 hrs after admission significantly predicted an unfavorable neurologic course in the traumatic brain injury group.. Significantly elevated S-100B and interleukin-8 serum levels 12 hrs after cardiac arrest suggest that primary brain damage and systemic inflammatory response are comparably serious with that of traumatic brain injury. In both collectives, increased S-100B values measured 12 hrs after insult correlated well with an unfavorable neurologic outcome after 12 months.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Brain Injuries; Case-Control Studies; Female; Germany; Glasgow Outcome Scale; Heart Arrest; Humans; Interleukin-8; Logistic Models; Male; Middle Aged; Multivariate Analysis; Nerve Growth Factors; Prospective Studies; ROC Curve; S100 Calcium Binding Protein beta Subunit; S100 Proteins; Sensitivity and Specificity; Treatment Outcome

The objectives of this study were to analyze changes in serum interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) levels in patients that restored spontaneous circulation after cardiopulmonary arrest (CPA), and to clarify the cause and significance of elevated serum cytokines after resuscitation. Twenty-eight patients who were admitted to our hospital after out of hospital CPA were studied. Patients' IL-8 levels and TNF-alpha levels in serum increased to a peak within 12 h and within 6 h after the return of spontaneous circulation (ROSC), respectively. Serum IL-8 levels in patients who died or became brain dead within 1 week after ROSC were significantly higher than those in other patients. In stepwise multiple regression analysis, maximum IL-8 values were significantly correlated with maximum TNF-alpha values within post-ROSC 24 h, with the total dose of administered epinephrine and with peripheral neutrophil counts. It is especially noteworthy that the total dose of epinephrine administered during and after resuscitation markedly influenced the elevation of serum IL-8 after ROSC. The increases in serum IL-8 induced by excessive administration of epinephrine might be harmful in the ROSC-patients resuscitated after CPA.

Topics: Cardiopulmonary Resuscitation; Epinephrine; Female; Heart Arrest; Humans; Interleukin-8; Male; Middle Aged; Regression Analysis; Reperfusion Injury; Time Factors; Tumor Necrosis Factor-alpha

To assess differences in serum interleukin-8 concentrations in resuscitated and nonresuscitated patients after cardiopulmonary resuscitation (CPR), and to compare changes of interleukin-8 levels with hemodynamic variables after restoration of spontaneous circulation, 39 patients with out-of-hospital cardiopulmonary arrest who had undergone CPR were studied. Venous blood samples were taken after CPR and 1 and 2 hours after restoration of spontaneous circulation to measure serum interleukin-8 levels by the enzyme-linked immunosorbent assay method. The median serum interleukin-8 levels after CPR were significantly higher in resuscitated than in nonresuscitated patients (64.9 pg/ml; range 30.2 to 1497 vs 0 pg/ml; range 0 to 31.6 pg/ml; p < 0.001). One and 2 hours after restoration of spontaneous circulation, the median serum interleukin-8 levels were 96.2 pg/ml and 155.4 pg/ml, respectively. Mean values of systolic blood pressure immediately after and 1 and 2 hours after restoration of spontaneous circulation were 117 +/- 9 mm Hg, 130 +/- 11 mm Hg, and 136 +/- 13 mm Hg, respectively. No significant correlations were found between hemodynamic values and serum interleukin-8 levels. In conclusion, successful initial resuscitation was associated with increased serum interleukin-8 concentrations. The interleukin-8 levels remained at high values 2 hours after restoration of spontaneous circulation.

Topics: Adult; Aged; Aged, 80 and over; Cardiopulmonary Resuscitation; Female; Heart Arrest; Humans; Immunoenzyme Techniques; Interleukin-8; Male; Middle Aged; Prospective Studies; Treatment Outcome