Kinetics and characteristics of an acute phase response following cardiac arrest

• Published in: Intensive care medicine Vol. 25; no. 12; pp. 1386 - 1394
• Main Authors: OPPERT, M, GLEITER, C. H, MÜLLER, C, REINICKE, A, VON AHSEN, N, FREI, U, ECKARDT, K.-U
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.12.1999; Berlin Springer Nature B.V
• Subjects: Acute phase proteins; Acute-Phase Proteins - metabolism; Acute-Phase Reaction - etiology; Adolescent; Adult; Aged; Amyloid; Amyloid precursor protein; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anoxia; Biological and medical sciences; C-reactive protein; Cardiac arrest; Cardiopulmonary Resuscitation; Complications; CPR; Cytokines; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Erythropoietin; Erythropoietin - blood; Exposure; Female; Gene expression; Haptoglobin; Heart; Heart Arrest - blood; Heart Arrest - complications; Hemoglobins - metabolism; Humans; Hypoxia; Hypoxia - blood; In vivo methods and tests; Inflammation; Intensive care; Intensive care medicine; Kinetics; Male; Medical sciences; Middle Aged; Oxygen; Patients; Prospective Studies; Proteins; Reaction kinetics; Resuscitation; Time dependence; Transferrin; Transferrins; Human; Infection; Cardiocirculatory arrest; Acute phase protein; Ischemia; Pathophysiology; Cardiovascular disease
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s001340051086

Inflammation and hypoxia are frequently associated, but their interaction is poorly understood. In vitro studies have shown that hypoxia stimulates the genes of acute phase proteins (APP) and cytokines known to induce APP. We decided to determine kinetics and potential determinants of an acute phase response after cardiac arrest and to assess whether isolated moderate hypoxia can induce APP in humans in vivo. Prospective, observational study in patients and human experiment. Tertiary care university hospital. 22 patients after primarily successful cardiopulmonary resuscitation (CPR) and 7 healthy volunteers. None in patients; exposure of volunteers to simulated altitude (460 torr/6 h). Following CPR, type-1 APP (C-reactive protein, alpha 1-acidglycoprotein, serum amyloid A) and type-2 APP (haptoglobin, alpha 1-antitrypsin) increased consistently within 1-2 days and the 'negative' APP transferrin was downregulated. This APP response occurred irrespective of the cause of arrest, the estimated time of anoxia, clinical course or patient outcome and was not different in patients with and without infectious complications. Exposure of healthy volunteers to less severe but more prolonged hypoxia did not induce APP, although a time dependent increase of serum erythropoietin (EPO) was measurable under these conditions, indicating the activation of oxygen dependent gene expression. (i) A marked acute phase response occurs regularly after cardiac arrest, but within the complexity of this situation the severity of hypoxia is not a predominant determinant of this response. (ii) Despite in vitro evidence for similarities in the oxygen dependent regulation of APP and EPO production, the oxygen sensitivity of these proteins in vivo is different. (iii) Measurements of APP are not revealing regarding infectious complications in the early phase after CPR.