Urinary Interleukin-8 Is a Biomarker of Stress in Emergency Physicians, Especially with Advancing Age — The JOBSTRESS* Randomized Trial
Identifieur interne : 004414 ( Main/Exploration ); précédent : 004413; suivant : 004415Urinary Interleukin-8 Is a Biomarker of Stress in Emergency Physicians, Especially with Advancing Age — The JOBSTRESS* Randomized Trial
Auteurs : Frédéric Dutheil [France, Australie] ; Marion Trousselard [France] ; Christophe Perrier [France] ; Gérard Lac [France] ; Alain Chamoux [France] ; Martine Duclos [France] ; Geraldine Naughton [Australie] ; George Mnatzaganian [Australie] ; Jeannot Schmidt [France]Source :
- PLoS ONE [ 1932-6203 ] ; 2013.
Descripteurs français
- KwdFr :
- Adulte, Analyse de régression, Analyse multivariée, Facteurs de l'âge, Fatigue (urine), Femelle, Humains, Interleukine-8 (urine), Marqueurs biologiques (urine), Mâle, Médecins, Service hospitalier d'urgences, Sommeil, Stress psychologique (physiopathologie), Stress psychologique (urine), Vieillissement (urine), Épuisement professionnel (physiopathologie), Épuisement professionnel (urine), Études de suivi.
- MESH :
- physiopathologie : Stress psychologique, Épuisement professionnel.
- urine : Adulte, Analyse de régression, Analyse multivariée, Facteurs de l'âge, Fatigue, Femelle, Humains, Interleukine-8, Marqueurs biologiques, Mâle, Médecins, Service hospitalier d'urgences, Sommeil, Stress psychologique, Vieillissement, Épuisement professionnel, Études de suivi.
English descriptors
- KwdEn :
- Adult, Age Factors, Aging (urine), Biomarkers (urine), Burnout, Professional (physiopathology), Burnout, Professional (urine), Emergency Service, Hospital, Fatigue (urine), Female, Follow-Up Studies, Humans, Interleukin-8 (urine), Male, Multivariate Analysis, Physicians, Regression Analysis, Sleep, Stress, Psychological (physiopathology), Stress, Psychological (urine).
- MESH :
- chemical , urine : Biomarkers, Interleukin-8.
- physiopathology : Burnout, Professional, Stress, Psychological.
- urine : Aging, Burnout, Professional, Fatigue, Stress, Psychological.
- Adult, Age Factors, Emergency Service, Hospital, Female, Follow-Up Studies, Humans, Male, Multivariate Analysis, Physicians, Regression Analysis, Sleep.
Abstract
Emergency 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.
We 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.
Mean 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).
The 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.
Url:
DOI: 10.1371/journal.pone.0071658
PubMed: 23977105
PubMed Central: 3747272
Affiliations:
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Montpied Hospital, Clermont-Ferrand, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Emergency Department, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Auvergne (région administrative)</region><settlement type="city">Clermont-Ferrand</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Department of Occupational Medicine, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Occupational Medicine, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Auvergne (région administrative)</region><settlement type="city">Clermont-Ferrand</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff3"><addr-line>Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, Blaise Pascal University, Clermont-Ferrand, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, Blaise Pascal University, Clermont-Ferrand</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Auvergne (région administrative)</region><settlement type="city">Clermont-Ferrand</settlement></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>School of Exercise Science, Australian Catholic University, Melbourne, Victoria, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>School of Exercise Science, Australian Catholic University, Melbourne, Victoria</wicri:regionArea><wicri:noRegion>Victoria</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:aff id="aff5"><addr-line>Department of Sport Medicine and Functional Exploration, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Sport Medicine and Functional Exploration, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Auvergne (région administrative)</region><settlement type="city">Clermont-Ferrand</settlement></placeName></affiliation></author><author><name sortKey="Trousselard, Marion" sort="Trousselard, Marion" uniqKey="Trousselard M" first="Marion" last="Trousselard">Marion Trousselard</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Laboratory of Stress Neurophysiology, IRBA, Brétigny sur Orge, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratory of Stress Neurophysiology, IRBA, Brétigny sur Orge</wicri:regionArea><wicri:noRegion>Brétigny sur Orge</wicri:noRegion><wicri:noRegion>Brétigny sur Orge</wicri:noRegion></affiliation></author><author><name sortKey="Perrier, Christophe" sort="Perrier, Christophe" uniqKey="Perrier C" first="Christophe" last="Perrier">Christophe Perrier</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Emergency Department, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Emergency Department, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Auvergne (région administrative)</region><settlement type="city">Clermont-Ferrand</settlement></placeName></affiliation></author><author><name sortKey="Lac, Gerard" sort="Lac, Gerard" uniqKey="Lac G" first="Gérard" last="Lac">Gérard Lac</name><affiliation wicri:level="3"><nlm:aff id="aff3"><addr-line>Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, Blaise Pascal University, Clermont-Ferrand, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, Blaise Pascal University, Clermont-Ferrand</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Auvergne (région administrative)</region><settlement type="city">Clermont-Ferrand</settlement></placeName></affiliation></author><author><name sortKey="Chamoux, Alain" sort="Chamoux, Alain" uniqKey="Chamoux A" first="Alain" last="Chamoux">Alain Chamoux</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Department of Occupational Medicine, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Occupational Medicine, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Auvergne (région administrative)</region><settlement type="city">Clermont-Ferrand</settlement></placeName></affiliation></author><author><name sortKey="Duclos, Martine" sort="Duclos, Martine" uniqKey="Duclos M" first="Martine" last="Duclos">Martine Duclos</name><affiliation wicri:level="3"><nlm:aff id="aff3"><addr-line>Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, Blaise Pascal University, Clermont-Ferrand, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, Blaise Pascal University, Clermont-Ferrand</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Auvergne (région administrative)</region><settlement type="city">Clermont-Ferrand</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff7"><addr-line>INRA, UMR 1019, UNH, CRNH Auvergne, Clermont-Ferrand, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>INRA, UMR 1019, UNH, CRNH Auvergne, Clermont-Ferrand</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Auvergne (région administrative)</region><settlement type="city">Clermont-Ferrand</settlement></placeName></affiliation></author><author><name sortKey="Naughton, Geraldine" sort="Naughton, Geraldine" uniqKey="Naughton G" first="Geraldine" last="Naughton">Geraldine Naughton</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>School of Exercise Science, Australian Catholic University, Melbourne, Victoria, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>School of Exercise Science, Australian Catholic University, Melbourne, Victoria</wicri:regionArea><wicri:noRegion>Victoria</wicri:noRegion></affiliation></author><author><name sortKey="Mnatzaganian, George" sort="Mnatzaganian, George" uniqKey="Mnatzaganian G" first="George" last="Mnatzaganian">George Mnatzaganian</name><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Faculty of Health Sciences, Australian Catholic University, East Melbourne, Victoria, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Faculty of Health Sciences, Australian Catholic University, East Melbourne, Victoria</wicri:regionArea><wicri:noRegion>Victoria</wicri:noRegion></affiliation></author><author><name sortKey="Schmidt, Jeannot" sort="Schmidt, Jeannot" uniqKey="Schmidt J" first="Jeannot" last="Schmidt">Jeannot Schmidt</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Emergency Department, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Emergency Department, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Auvergne (région administrative)</region><settlement type="city">Clermont-Ferrand</settlement></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Age Factors</term><term>Aging (urine)</term><term>Biomarkers (urine)</term><term>Burnout, Professional (physiopathology)</term><term>Burnout, Professional (urine)</term><term>Emergency Service, Hospital</term><term>Fatigue (urine)</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Interleukin-8 (urine)</term><term>Male</term><term>Multivariate Analysis</term><term>Physicians</term><term>Regression Analysis</term><term>Sleep</term><term>Stress, Psychological (physiopathology)</term><term>Stress, Psychological (urine)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Analyse de régression</term><term>Analyse multivariée</term><term>Facteurs de l'âge</term><term>Fatigue (urine)</term><term>Femelle</term><term>Humains</term><term>Interleukine-8 (urine)</term><term>Marqueurs biologiques (urine)</term><term>Mâle</term><term>Médecins</term><term>Service hospitalier d'urgences</term><term>Sommeil</term><term>Stress psychologique (physiopathologie)</term><term>Stress psychologique (urine)</term><term>Vieillissement (urine)</term><term>Épuisement professionnel (physiopathologie)</term><term>Épuisement professionnel (urine)</term><term>Études de suivi</term></keywords><keywords scheme="MESH" type="chemical" qualifier="urine" xml:lang="en"><term>Biomarkers</term><term>Interleukin-8</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Stress psychologique</term><term>Épuisement professionnel</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Burnout, Professional</term><term>Stress, Psychological</term></keywords><keywords scheme="MESH" qualifier="urine" xml:lang="en"><term>Aging</term><term>Burnout, Professional</term><term>Fatigue</term><term>Stress, Psychological</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Age Factors</term><term>Emergency Service, Hospital</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Male</term><term>Multivariate Analysis</term><term>Physicians</term><term>Regression Analysis</term><term>Sleep</term></keywords><keywords scheme="MESH" qualifier="urine" xml:lang="fr"><term>Adulte</term><term>Analyse de régression</term><term>Analyse multivariée</term><term>Facteurs de l'âge</term><term>Fatigue</term><term>Femelle</term><term>Humains</term><term>Interleukine-8</term><term>Marqueurs biologiques</term><term>Mâle</term><term>Médecins</term><term>Service hospitalier d'urgences</term><term>Sommeil</term><term>Stress psychologique</term><term>Vieillissement</term><term>Épuisement professionnel</term><term>Études de suivi</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Emergency 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.</p></sec><sec><title>Methods</title><p>We 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.</p></sec><sec><title>Results</title><p>Mean 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).</p></sec><sec><title>Conclusion</title><p>The 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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Schneider, Sm" uniqKey="Schneider S">SM Schneider</name></author><author><name sortKey="Hamilton, Gc" uniqKey="Hamilton G">GC Hamilton</name></author><author><name sortKey="Moyer, P" uniqKey="Moyer P">P Moyer</name></author><author><name sortKey="Stapczynski, Js" uniqKey="Stapczynski J">JS Stapczynski</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Riggs, Lm" uniqKey="Riggs L">LM Riggs</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lindeberg, Si" uniqKey="Lindeberg S">SI Lindeberg</name></author><author><name sortKey="Rosvall, M" uniqKey="Rosvall M">M Rosvall</name></author><author><name 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uniqKey="Callaghan C">CJ Callaghan</name></author><author><name sortKey="Mackay, J" uniqKey="Mackay J">J Mackay</name></author><author><name sortKey="Charman, S" uniqKey="Charman S">S Charman</name></author><author><name sortKey="Nashef, Sa" uniqKey="Nashef S">SA Nashef</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Meier Ewert, Hk" uniqKey="Meier Ewert H">HK Meier-Ewert</name></author><author><name sortKey="Ridker, Pm" uniqKey="Ridker P">PM Ridker</name></author><author><name sortKey="Rifai, N" uniqKey="Rifai N">N Rifai</name></author><author><name sortKey="Regan, Mm" uniqKey="Regan M">MM Regan</name></author><author><name sortKey="Price, Nj" uniqKey="Price N">NJ Price</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Motivala, Sj" uniqKey="Motivala S">SJ Motivala</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Narasimamurthy, R" uniqKey="Narasimamurthy R">R Narasimamurthy</name></author><author><name sortKey="Hatori, M" uniqKey="Hatori M">M Hatori</name></author><author><name sortKey="Nayak, Sk" uniqKey="Nayak S">SK Nayak</name></author><author><name sortKey="Liu, F" uniqKey="Liu F">F Liu</name></author><author><name sortKey="Panda, S" uniqKey="Panda S">S Panda</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Australie</li><li>France</li></country><region><li>Auvergne (région administrative)</li><li>Auvergne-Rhône-Alpes</li></region><settlement><li>Clermont-Ferrand</li></settlement></list><tree><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Dutheil, Frederic" sort="Dutheil, Frederic" uniqKey="Dutheil F" first="Frédéric" last="Dutheil">Frédéric Dutheil</name></region><name sortKey="Chamoux, Alain" sort="Chamoux, Alain" uniqKey="Chamoux A" first="Alain" last="Chamoux">Alain Chamoux</name><name sortKey="Duclos, Martine" sort="Duclos, Martine" uniqKey="Duclos M" first="Martine" last="Duclos">Martine Duclos</name><name sortKey="Duclos, Martine" sort="Duclos, Martine" uniqKey="Duclos M" first="Martine" last="Duclos">Martine Duclos</name><name sortKey="Dutheil, Frederic" sort="Dutheil, Frederic" uniqKey="Dutheil F" first="Frédéric" last="Dutheil">Frédéric Dutheil</name><name sortKey="Dutheil, Frederic" sort="Dutheil, Frederic" uniqKey="Dutheil F" first="Frédéric" last="Dutheil">Frédéric Dutheil</name><name sortKey="Dutheil, Frederic" sort="Dutheil, Frederic" uniqKey="Dutheil F" first="Frédéric" last="Dutheil">Frédéric Dutheil</name><name sortKey="Lac, Gerard" sort="Lac, Gerard" uniqKey="Lac G" first="Gérard" last="Lac">Gérard Lac</name><name sortKey="Perrier, Christophe" sort="Perrier, Christophe" uniqKey="Perrier C" first="Christophe" last="Perrier">Christophe Perrier</name><name sortKey="Schmidt, Jeannot" sort="Schmidt, Jeannot" uniqKey="Schmidt J" first="Jeannot" last="Schmidt">Jeannot Schmidt</name><name sortKey="Trousselard, Marion" sort="Trousselard, Marion" uniqKey="Trousselard M" first="Marion" last="Trousselard">Marion Trousselard</name></country><country name="Australie"><noRegion><name sortKey="Dutheil, Frederic" sort="Dutheil, Frederic" uniqKey="Dutheil F" first="Frédéric" last="Dutheil">Frédéric Dutheil</name></noRegion><name sortKey="Mnatzaganian, George" sort="Mnatzaganian, George" uniqKey="Mnatzaganian G" first="George" last="Mnatzaganian">George Mnatzaganian</name><name sortKey="Naughton, Geraldine" sort="Naughton, Geraldine" uniqKey="Naughton G" first="Geraldine" last="Naughton">Geraldine Naughton</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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