AI Article Synopsis
- The STEROHCA trial studied the effect of high-dose glucocorticoids on inflammation in patients who suffered out-of-hospital cardiac arrest (OHCA), showing promising results in reducing inflammatory markers.
- In a sample of 137 OHCA patients, those who received glucocorticoids had improved anti-inflammatory responses compared to the placebo group, with survival rates of 75% vs. 64% at 180 days.
- The treatment significantly reduced several pro-inflammatory cytokines within 24 hours of administration, indicating potential benefits of glucocorticoids in managing post-cardiac arrest syndrome.
Article 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.
Trial Registration: EudraCT number: 2020-000855-11; submitted March 30, 2020. URL: https://www.
Clinicaltrials: gov; Unique Identifier: NCT04624776.
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| http://dx.doi.org/10.1016/j.resuscitation.2024.110340 | DOI Listing |
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