{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T11:27:35Z","timestamp":1787052455489,"version":"build-2736575974"},"reference-count":23,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Post-cardiac arrest syndrome (PCAS) involves a complex interplay between systemic inflammatory and compensatory anti-inflammatory responses. The hyperacute kinetics of these cytokines and their incremental prognostic value beyond established brain injury biomarkers remain inadequately characterized. We aimed to evaluate whether the 6 h post\u2013return-of-spontaneous-circulation (ROSC) cytokine profile predicts neurological outcome, with the Th1\/Th2 ratio largely reflecting the IL-10 signal. Methods: This retrospective analysis of prospectively collected data from a single-center cardiac arrest registry included 56 cardiac arrest survivors (40 out-of-hospital, 16 in-hospital) treated with targeted temperature management (TTM) at 33 \u00b0C or 36 \u00b0C between January 2024 and December 2025. Serum IL-6, IL-10, IFN-\u03b3 (interferon-\u03b3), and TNF-\u03b1 (tumor necrosis factor-\u03b1) were measured at five time points (initial presentation (INIT), and 6, 24, 48, and 72 h post-ROSC). Neurological outcome was assessed using the Cerebral Performance Category (CPC) scale at 6 months after cardiac arrest, with poor outcome defined as CPC 3\u20135. Results: Eighteen patients (32.1%) had a good outcome (CPC 1\u20132) and 38 (67.9%) had a poor outcome at 6 months after cardiac arrest. Among the 38 poor-outcome patients, 2 were classified as CPC 3, 8 as CPC 4, and 28 as CPC 5 (death) at 6 months; the 6-month outcome was available for all 56 patients, with no loss to follow-up. Patients with poor outcomes exhibited a synchronized surge of IL-6 and IL-10 peaking at 6 h post-ROSC. IL-10 at 6 h showed the highest discriminative power among cytokines (area under the curve (AUC) 0.844) compared with IL-6 (AUC 0.761). Multivariable analysis using Youden-derived cut-offs revealed that IL-10 \u2265 154.32 pg\/mL (adjusted odds ratio (aOR) 15.28, 95% CI 2.02\u2013115.38, p = 0.008) and a Th1\/Th2 ratio \u2265 0.0314 (aOR 0.09, 95% CI 0.01\u20130.61, p = 0.013) were independently associated with neurological outcome after adjustment for age and initial shockable rhythm. Conclusions: The 6 h post-ROSC window is a critical inflection point for immune dysregulation in PCAS. Early IL-10 elevation and collapse of the Th1\/Th2 balance are independently associated with poor neurological recovery and add incremental prognostic information to established brain injury biomarkers. External validation in larger prospective cohorts is required.<\/jats:p>","DOI":"10.3390\/jcm15166376","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T10:22:52Z","timestamp":1787048572000},"page":"6376","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hyperacute Cytokine Kinetics and Early Interleukin-10 Elevation as Predictors of Neurological Outcome in Post-Cardiac Arrest Syndrome"],"prefix":"10.3390","volume":"15","author":[{"given":"Jea Hun","family":"Oh","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2673-2950","authenticated-orcid":false,"given":"Hyo Joon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Man","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5104-9806","authenticated-orcid":false,"given":"Daehee","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Incheon St. Mary\u2019s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7630-2046","authenticated-orcid":false,"given":"Kiwook","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Uijeongbu St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In Soo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Daejeon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8701-942X","authenticated-orcid":false,"given":"Ji Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Bucheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6709-7703","authenticated-orcid":false,"given":"Chun Song","family":"Youn","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5549-1148","authenticated-orcid":false,"given":"Sang Hoon","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyo Jin","family":"Bang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ae Kyung","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Sook","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1161\/01.CIR.0000023891.80661.AD","article-title":"Successful cardiopulmonary resuscitation after cardiac arrest as a 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