Serum markers of brain injury can predict good neurological outcome after out-of-hospital cardiac arrest.

Biomarkers Brain Injuries Humans Out-of-Hospital Cardiac Arrest / therapy Phosphopyruvate Hydratase Prognosis Prospective Studies Retrospective Studies
Blood biomarkers Cardiac arrest ERC/ESICM guidelines Good neurological outcome Neurofilament light Prognostication

Journal

Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851

Informations de publication

Date de publication:
Sep 2021
Historique:
received: 11 06 2021
accepted: 13 07 2021
pubmed: 22 8 2021
medline: 14 10 2021
entrez: 21 8 2021
Statut: ppublish

Résumé

The majority of unconscious patients after cardiac arrest (CA) do not fulfill guideline criteria for a likely poor outcome, their prognosis is considered "indeterminate". We compared brain injury markers in blood for prediction of good outcome and for identifying false positive predictions of poor outcome as recommended by guidelines. Retrospective analysis of prospectively collected serum samples at 24, 48 and 72 h post arrest within the Target Temperature Management after out-of-hospital cardiac arrest (TTM)-trial. Clinically available markers neuron-specific enolase (NSE) and S100B, and novel markers neurofilament light chain (NFL), total tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) were analysed. Normal levels with a priori cutoffs specified by reference laboratories or defined from literature were used to predict good outcome (no to moderate disability, Cerebral Performance Category scale 1-2) at 6 months. Seven hundred and seventeen patients were included. Normal NFL, tau and GFAP had the highest sensitivities (97.2-98% of poor outcome patients had abnormal serum levels) and NPV (normal levels predicted good outcome in 87-95% of patients). Normal S100B and NSE predicted good outcome with NPV 76-82.2%. Normal NSE correctly identified 67/190 (35.3%) patients with good outcome among those classified as "indeterminate outcome" by guidelines. Five patients with single pathological prognostic findings despite normal biomarkers had good outcome. Low levels of brain injury markers in blood are associated with good neurological outcome after CA. Incorporating biomarkers into neuroprognostication may help prevent premature withdrawal of life-sustaining therapy.

Identifiants

DOI: 10.1007/s00134-021-06481-4 PMID: 34417831 PMC: PMC8421280
pubmed: 34417831
doi: 10.1007/s00134-021-06481-4
pii: 10.1007/s00134-021-06481-4
pmc: PMC8421280
doi:

Substances chimiques

Biomarkers 0
Phosphopyruvate Hydratase EC 4.2.1.11

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

984-994

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

© 2021. The Author(s).

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Auteurs

Marion Moseby-Knappe (M)

Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Getingevägen 4, 222 41, Lund, Sweden. marion.moseby_knappe@med.lu.se.
ORCID: 0000-0001-8160-5957

Niklas Mattsson-Carlgren (N)

Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Getingevägen 4, 222 41, Lund, Sweden.
Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden.
Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden.

Pascal Stammet (P)

Medical and Health Department, National Fire and Rescue Corps, Luxembourg, Luxembourg.

Sofia Backman (S)

Department of Clinical Sciences Lund, Clinical Neurophysiology, Skåne University Hospital, Lund University, Lund, Sweden.

Kaj Blennow (K)

Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden.
Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.

Josef Dankiewicz (J)

Department of Clinical Sciences Lund, Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.

Hans Friberg (H)

Department of Clinical Sciences Lund, Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Malmö, Sweden.

Christian Hassager (C)

Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

Janneke Horn (J)

Department of Intensive Care, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands.

Jesper Kjaergaard (J)

Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.

Gisela Lilja (G)

Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Getingevägen 4, 222 41, Lund, Sweden.

Christian Rylander (C)

Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.

Susann Ullén (S)

Clinical Studies Sweden-Forum South, Skane University Hospital, Lund, Sweden.

Johan Undén (J)

Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Department of Operation and Intensive Care, Lund University, Hallands Hospital Halmstad, Halland, Sweden.

Erik Westhall (E)

Department of Clinical Sciences Lund, Clinical Neurophysiology, Skåne University Hospital, Lund University, Lund, Sweden.

Matt P Wise (MP)

Adult Critical Care, University Hospital of Wales, Cardiff, UK.

Henrik Zetterberg (H)

Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden.
Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.
UK Dementia Research Institute at UCL, London, UK.
Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China.

Niklas Nielsen (N)

Department of Clinical Sciences Lund, Anaesthesia and Intensive Care, Helsingborg Hospital, Lund University, Lund, Sweden.

Tobias Cronberg (T)

Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Getingevägen 4, 222 41, Lund, Sweden.

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