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Elevations of inflammatory markers PTX3 and sST2 after resuscitation from cardiac arrest are associated with multiple organ dysfunction syndrome and early death

  • Giuseppe Ristagno , Tero Varpula , Serge Masson , Marta Greco , Barbara Bottazzi , Valentina Milani , Aneta Aleksova , Gianfranco Sinagra , Roberto Assandri , Marjaana Tiainen , Jukka Vaahersalo , Jouni Kurola , Simona Barlera , Alessandro Montanelli , Roberto Latini , Ville Pettilä , Stepani Bendel , Markus B. Skrifvars EMAIL logo and for the FINNRESUSCI Study Group
Published/Copyright: March 14, 2015
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 53 Issue 11

Abstract

Background: A systemic inflammatory response is observed after cardiopulmonary resuscitation. We investigated two novel inflammatory markers, pentraxin 3 (PTX3) and soluble suppression of tumorigenicity 2 (sST2), in comparison with the classic high-sensitivity C-reactive protein (hsCRP), for prediction of early multiple organ dysfunction syndrome (MODS), early death, and long-term outcome after out-of-hospital cardiac arrest.

Methods: PTX3, sST2, and hsCRP were assayed at ICU admission and 48 h later in 278 patients. MODS was defined as the 24 h non-neurological Sequential Organ Failure Assessment (SOFA) score ≥12. Intensive care unit (ICU) death and 12-month Cerebral Performance Category (CPC) were evaluated.

Results: In total, 82% of patients survived to ICU discharge and 48% had favorable neurological outcome at 1 year (CPC 1 or 2). At ICU admission, median plasma levels of hsCRP (2.8 mg/L) were normal, while levels of PTX3 (19.1 ng/mL) and sST2 (117 ng/mL) were markedly elevated. PTX3 and sST2 were higher in patients who developed MODS (p<0.0001). Admission levels of PTX3 and sST2 were also higher in patients who died in ICU and in those with an unfavorable 12-month neurological outcome (p<0.01). Admission levels of PTX3 and sST2 were independently associated with subsequent MODS [OR: 1.717 (1.221–2.414) and 1.340, (1.001–1.792), respectively] and with ICU death [OR: 1.536 (1.078–2.187) and 1.452 (1.064–1.981), respectively]. At 48 h, only sST2 and hsCRP were independently associated with ICU death.

Conclusions: Higher plasma levels of PTX3 and sST2, but not of hsCRP, at ICU admission were associated with higher risk of MODS and early death.

Keywords: cardiac arrest; pentraxin 3 (PTX3); ST2
Corresponding author: Markus B. Skrifvars, MD, PhD, EDIC, FCICM, Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PL 340, 00029 HUS, Helsinki, Finland, Phone: +35 8405137862, Fax: +358947178354, E-mail:

Acknowledgments

The authors acknowledge the great collaborative efforts of all the participants of the FINNRESUSCI study, especially the study doctors and nurses in the participating ICUs. We also thank Tieto Ltd, Helsinki for processing the database of the Finnish Intensive Care Consortium.

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Financial support: The study was supported by competitive research grants from: (1) Laerdal Foundation for Acute Medicine, Stavanger, Norway, competing grant project support 2010–2013 to G.R.; (2) Helsinki University Hospital T102010070, Medicinska Understödsföreningen Liv och Hälsa 2012, Finska Läkaresällskapet 2011 to M.B.S.; and (3) European Commission (FP7-HEALTH-2011-ADITEC-280873) to B.B.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2014-12-23
Accepted: 2015-2-13
Published Online: 2015-3-14
Published in Print: 2015-10-1

©2015 by De Gruyter

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https://doi.org/10.1515/cclm-2014-1271
Keywords for this article
cardiac arrest; pentraxin 3 (PTX3); ST2

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Laboratory medicine does matter in science (and medicine)… yet many seem to ignore it
  4. The standardization of the urine albumin assays: no longer deferrable
  5. Reviews
  6. The role of telomeres and vitamin D in cellular aging and age-related diseases
  7. Atypical hemolytic uremic syndrome: from diagnosis to treatment
  8. Clinical relevance and contemporary methods for counting blood cells in body fluids suspected of inflammatory disease
  9. EFLM Opinion Paper
  10. How to assess the quality of your analytical method?
  11. Genetics and Molecular Diagnostics
  12. Validation of CFTR intronic variants identified during cystic fibrosis population screening by a minigene splicing assay
  13. General Clinical Chemistry and Laboratory Medicine
  14. Uncertainty in measurement for 43 biochemistry, immunoassay, and hemostasis routine analytes evaluated by a method using only external quality assessment data
  15. A study examining the bias of albumin and albumin/creatinine ratio measurements in urine
  16. National survey on appropriateness of clinical biochemistry reporting in China
  17. Potentiometric measurement of urinary iodine concentration in patients with thyroid diseases with and without previous exposure to non-radioactive iodine
  18. Determination of 21-hydroxylase autoantibodies: inter-laboratory concordance in the Euradrenal International Serum Exchange Program
  19. Value of a commercial kit for detecting anti-C1q autoantibodies and correlation with immunological and clinical activity of lupus nephritis
  20. Comparison of the bead-based simultaneous analysis of specific platelet antibodies assay (SASPA) and Pak Lx Luminex technology with the monoclonal antibody immobilization of platelet antigens assay (MAIPA) to detect platelet alloantibodies
  21. Measurement of the inflammatory response in the early postoperative period after hip and knee arthroplasty
  22. Whole blood thromboelastometry profiles in women with preeclampsia
  23. Increased plasma soluble urokinase plasminogen activator receptor levels in systemic sclerosis: possible association with microvascular abnormalities and extent of fibrosis
  24. Reference Values and Biological Variations
  25. Reference ranges of serum bile acids in children and adolescents
  26. Infectious Diseases
  27. Elevated circulating ghrelin, but not peptide YY(3-36) levels, in term neonates with infection
  28. Cardiovascular Diseases
  29. Head-to-head comparison of 10 natriuretic peptide assays
  30. Prognostic role of BNP in children undergoing surgery for congenital heart disease: analysis of prediction models incorporating standard risk factors
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  32. Identification of molecular species of oxidized triglyceride in plasma and its distribution in lipoproteins
  33. A new formula for estimation of low-density lipoprotein cholesterol in an ethnic Chinese population
  34. Letter to the Editors
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  39. Comparison study of two commercially available methods for the determination of golimumab and anti-golimumab antibody levels in patients with rheumatic diseases
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  43. The risk of macrovascular complications in subjects genotyped for common IL-6 gene and TNF-α gene variants
  44. Comparison of nucleated red blood cell count with four commercial hematological analyzers
  45. Reply to: The risk of macrovascular complications in subjects genotyped for common IL-6 gene and TNF-α gene variants
  46. Congress Abstracts
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  48. 47th National Congress of the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC – Laboratory Medicine)
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