Correlation Between The Level Of Serum IL-10 And CPC Score In Patients With ROSC After Cardiac Arrest And Analysis Of Influencing Factors Of Neurological Function Prognosis

Objective:To explore the correlation between the level of serum interleukin 10（IL-10）at early stage of restoration of spontaneous circulation（ROSC）after cardiopulmonary resuscitation（CPR）in patients with cardiac arrest（CA）and cerebral performance category（CPC）score at 28 days after CA,and to analyze the factors that may affect the prognosis of cranial function in patients with ROSC.Methods:CA patients treated in the Emergency Department of the First Affiliated Hospital of China Medical University from July 2021 to December 2022 were selected as subjects according to inclusion and exclusion criteria.Patients who achieved sustained ROSC after cardiopulmonary resuscitation were selected as subjects.All patients with CA were judged and treated in accordance with the 2020 American Heart Association（AHA）Guidelines for cardiopulmonary resuscitation and cardiovascular first Aid Basic and Advanced Life Support（AHA 2020 Guidelines）.In hospital patients with CA,early identification and immediate rescue measures could be taken through ECG monitoring.The basic information of enrolled patients（gender,age,main diagnosis,etc.）,cardiac arrest time,initial monitoring rhythm,start and end time of CPR,compression method,defibrillation,resuscitation medication,ventilation and ventilation method,ROSC time,first blood gas analysis index after ROSC（p H,Pa O₂,Pa CO₂,Lac）were recorded.After resuscitation,whether mild hypothermia,vasoactive drugs,invasive mechanical ventilation,sedation,glucocorticoid and other treatments.Serum IL-10,IL-6and neuron-specific enolase（NSE）were detected within 48 hours after ROSC.Phone follow-up at 28 days after CA and medical records were consulted for CPC score,and the patients were divided into good neurological function prognosis group（CPC1-2）and poor neurological function prognosis group（CPC3-5）.Univariate analysis and comparison of various indicators between the two groups were performed,Pearson and Spearman correlation analysis and multivariate Logistic regression analysis were performed for indicators with statistical differences,and ROC curve was used to evaluate the predictive value of early serum biomarker level after ROSC on the prognosis of cerebral nerve function in patients with resuscitate cardiac arrest.Results:61 patients were enrolled in this study.According to the 28-day CPC score after ROSC,there were 23 patients in the good group and 38 patients in the poor group.A comparative analysis of clinical data between the two groups showed that the dose of adrenalin used in resuscitation group with poor prognosis was higher than that in good group[4.0（2.0,5.0）mg VS 1.0（0.0,2.0）mg,Z=4.18,P<0.05].The duration of CPR in poor group was longer than that in good group[14.0（9.0,20.8）min VS 6.0（5.0,10.0）min,Z=4.51,P<0.05].The level of first arterial blood gas Lac after ROSC in poor group was higher than that in good group[8.25（4.45,11.75）mmol/L VS 2.10（1.30,2.95）mmol/L,Z=4.59,P<0.05].The p H level of the bad group was lower than that of the good group（7.22±0.14 VS 7.38±0.07,t=5.34,P<0.05）.And initial monitoring heart rate（x²=5.96,P<0.05）,whether defibrillation（x²=5.15,P<0.05）recovery when different ventilation methods（x²=19.98,P<0.05）and recovery after mechanical ventilation therapy（x²=14.22,P<0.05）,the recovery after whether hypothermia treatment（x²=4.21,P<0.05）compare the differences between the two groups have statistical significance.Age,gender,main causes of CA（cardiogenic,non-cardiogenic）,chest external pressure II（free hand pressure,LUCAS assisted pressure）,resuscitation medication（dopamine,sodium bicarbonate）,first blood gas Pa CO₂after ROSC,and there were no significant differences in Pa O₂level and post-resuscitation treatment（sedation,vasoactive drugs,glucocorticoids）between the two groups,all P>0.05.Non-parametric rank sum test was performed to compare the levels of serum IL-10,IL-6 and NSE within48h,and it was found that the level of IL-10 in the poor prognosis group was higher than that in the good prognosis group[28.02（18.55,37.80）pg/m L VS 8.49（2.44,19.00）pg/m L,Z=4.77,P<0.05];The level of NSE in poor group was higher than that in good group[31.90（23.33,39.19）ng/m L VS 15.11（9.60,20.16）ng/m L,Z=5.04,P<0.05].The level of IL-6 in poor group was higher than that in good group[108.46（68.09,290.22）VS 38.04（15.79,100.86）pg/m L,Z=3.80,P<0.05].Pearson correlation analysis showed that serum IL-10 was correlated with NSE（r=0.58,P<0.05）,IL-6（r=0.54,P<0.05）,resuscitation epinephrine dose（r=0.46,P<0.05）,duration of CPR（r=0.42,P<0.05）,the first blood gas Lac（r=0.33,P<0.05）after ROSC had a positive correlation,and the initial blood gas p H level after ROSC had a negative correlation（r=-0.37,P<0.05）.Spearman rank correlation analysis showed a significant positive correlation between serum NSE level and CPC score within 48h after ROSC（r=0.83,P<0.05）,and serum IL-10 within 48h after ROSC（r=0.72,P<0.05）,IL-6（r=0.58,P<0.05）levels were positively correlated with CPC scores.Multivariate logistic regression found that the level of Lac at first arterial blood gas analysis after ROSC had a statistically significant effect on the prognosis（OR=1.50,95%CI 1.07-2.09,P<0.05）.In the multivariate analysis,initial monitoring of heart rhythm during CA,defibrillation,ventilation mode during resuscitation,dosage of adrenalin during resuscitation,duration of CPR,p H value of blood gas after the first ROSC,mechanical ventilation after resuscitation,and mild hypothermia were not statistically significant for prognosis（all P>0.05）.ROC curve was used to analyze the predictive value of serum IL-10,IL-6 and NSE levels within 48h after ROSC,adrenalin dose during resuscitation,duration of CPR and Lac on the prognosis of neurological function in patients with ROSC.The results show that:AUC IL-10 combined with NSE（0.949）>AUC NSE（0.912）>AUC IL-10（0.889）>AUC Lac（0.885）>AUC duration of CPR（0.837）>AUC adrenalin dose（0.813）>AUCIL-6（0.806）.The optimal cut-off value of IL-10 was 24.58pg/ml,the sensitivity was 81.0%,the specificity was 90.0%,and the Yoden index was 0.71.The AUC of IL-10 combined with NSE was 0.949,the sensitivity was 87.0%,the specificity was 91.0%,and the Yoden index was 0.78.Conclusion:（1）The level of early serum IL-10 in ROSC patients with cardiac arrest is correlated with CPC score,which has a good predictive value for the prognosis of neurological function.（2）The value of early serum IL-10 combined with NSE in predicting the prognosis of neurological function in ROSC patients with cardiac arrest is significantly increased.（3）The level of Lac at first arterial blood gas analysis is an independent risk factor for the prognosis of cerebral nerve function in patients with ROSC after cardiac arrest resuscitation.