Urinary Interleukin-8 Is a Biomarker of Stress in Emergency Physicians, Especially with Advancing Age — The JOBSTRESS* Randomized Trial

Abstract

BackgroundEmergency physicians are exposed to greater stress during a 24-hour shift (24 hS) than a 14-hour night shift (14 hS), with an impact lasting several days. Interleukin-8 (IL-8) is postulated to be a chronic stress biomarker. However, no studies have tracked IL-8 over several shifts or used it for monitoring short-term residual stress. The IL-8 response to the shifts may also increase with age. Conveniently, IL-8 can be measured non-intrusively from urine.MethodsWe conducted a shifts-randomized trial comparing 17 emergency physicians’ urinary IL-8 levels during a 24 hS, a 14 hS, and a control day (clerical work on return from leave). Mean levels of IL-8 were compared using a Wilcoxon matched-pairs test. Independent associations of key factors including shifts, stress, and age with IL-8 levels were further assessed in a multivariable generalized estimating equations model.ResultsMean urinary IL-8 levels almost doubled during and after a 24 hS compared with a 14 hS or a control day. Furthermore, IL-8 levels failed to return to control values at the end of the third day after the shift despite a rest day following the 24 hS. In the multivariable model, engaging in a 24 hS, self-reported stress, and age were independently associated with higher IL-8 levels. A 24 hS significantly increased IL-8 levels by 1.9 ng (p = .007). Similarly, for every unit increase in self-reported stress, there was a 0.11 ng increase in IL-8 levels (p = .003); and for every one year advance in age of physicians, IL-8 levels also increased by 0.11 ng (p = .018).ConclusionThe 24 hS generated a prolonged response of the immune system. Urinary IL-8 was a strong biomarker of stress under intensive and prolonged demands, both acutely and over time. Because elevated IL-8 levels are associated with cardiovascular disease and negative psychological consequences, we suggest that emergency physicians limit their exposure to 24 hS, especially with advancing age.

PTSD as the second tsunami of the SARS-Cov-2 pandemic

“…In a context of disaster medicine with a lack of human and technical resources, emergency teams had to separate SARS-Cov-2 cases from others, and contagious from non-contagious (Wong et al, 2020). In routine clinical practice, life-and-death emergencies are already a major stressor for medical doctors (Dutheil et al, 2012(Dutheil et al, , 2013. In the context of the SARS-Cov-2 pandemic, choosing which patients may benefit from assisted ventilationand thus live or dieis an additional major factor of stress.…”

Serum Concentrations of Angiotensin, C-Reactive Protein, Interleukin-8, and Tumor Necrosis Factor-α in Train Driver Population

“…Indeed, the alteration of the immune parameters was observed among some specific occupational groups prone to workplace stress such as blue-collar workers, paratroops, and nurses [25]. Furthermore, work-related exhaustion can lead to various physical and psychological symptoms, and also may be associated with delayed decision-making, causing mistakes and heavy losses [21].…”

“…In addition to its potent chemotactic activity, it can induce proliferation and migration of cancer cells [20]. Because elevated IL-8 levels are associated with cardiovascular disease and negative psychological consequences, IL-8 is postulated to be a chronic stress biomarker [21].…”

Classifying heartrate by change detection and wavelet methods for emergency physicians

“…Illustration on how we construct the variables ∆τ, ∆θ exclusion criteria were endocrine disease, pregnancy, deleterious life event, any current illness, anti-inflammatory or chronotropic drugs...etc. The ECG signal analysis was investigated on 24 hours electrocardiogram recorded from 8h30 until 8h30 the next morning; more details about the protocol and data collection can be found in [10]. For technical testing of our approach, we will only use one subject for which the ECG signal has been cleaned by removing the Holter artifact measures and converted to RR signal.…”

“…Indeed ECG signal analysis has a long story after the implementation of the ambulatory monitoring by Holter at the beginning of the fifties. Recent measurement methods, see [8,10], allow us to record ECG data for healthy people over a long period of time: long distance (marathon) runners, individuals daily (24 hours) records, etc. .…”