Change in the Intrathecal Cytokine level in Hypoxic-ischemic Encephalopathy after Cardiac Arrest

Lee,  Woon Jeoung; Park,  Kyu Nam; Jeong,  Si Kyoung; Youn,  Chun Song; Kim,  Se Kyung

J Korean Soc Emerg Med > Volume 14(5); 2003 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2003;14(5): 494-499.

Change in the Intrathecal Cytokine level in Hypoxic-ischemic Encephalopathy after Cardiac Arrest

Woon Jeoung Lee, Kyu Nam Park, Si Kyoung Jeong, Chun Song Youn, Se Kyung Kim

Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. emsky@catholic.ac.kr

ABSTRACT

PURPOSE:
This study was performed to evaluate the changes in the IL-1beta and the IL-6 concentrations in cerebrospinal fluid (CSF) after initial successful cardiopulmonary resuscitation (CPR), to examine the difference in the IL-1beta and the IL-6 concentrations in CSF between the cerebral performance category (CPC) 1-2 group and CPC 3-5 group after successful CPR, and to identify early makers predicting the outcome after successful CPR.
METHODS:
We studied prospectively 10 patients with spontaneous circulation after CPR. Samples of CSF were taken at 20 min, 4 hr, 24 hr, and 48 hr after restoration of spontaneous circulation. The control group was consisted of the nonspecific 6 patients in brain computed tomography and CSF finding among the visited patients in emergency department with complaints of headache. The CSF IL-1beta and IL-6 were measured by using enzyme-linked immunosorbent assays.
RESULTS:
1) The concentrations of CSF IL-6 for CPC 3-5 were higher in the successful CPR group than in the control group. 2) In the severely neurologically disabled group (CPC 3-5), the concentrations of CSF IL-6 were significantly higher at 20 min 4 hr, 24 hr and 48 hr after successful CPR than they were in the mildly neurologically disabled group(CPC 1-2). 3) The concentrations of CSF IL-6 in the severely neurologically disabled group (CPC 3-5) reached peak levels at 24 hours after successful CPR. 4) The concentrations of CSF IL-1beta did not differ between the two groups.
CONCLUSION:
Our study indicates that CSF IL-6 is increased more in the severely neurologically disabled group (CPC 3-5) than it is in the mildly neurologically disabled group (CPC 1-2) after successful CPR. We found a significant relationship between the concentration of CSF IL-6 and initial outcome for the CPR patient. Thus, we suggest that CSF IL-6 might play a role in brain ischemic-reperfusion injury and might be used as a prognostic marker after successful CPR.

Key words: Cardiac arrest, Cerebrospinal fluid, Interleukin-1beta, Interleukin-6, Cerebral performance category, Brain, Ischemic-reperfusion injury