Journal Article

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

Cronberg, Tobias, Undén, Johan, Moseby-Knappe, Marion, Dankiewicz, Josef, Zetterberg, Henrik, Mattsson-Carlgren, Niklas, Hassager, Christian, Rylander, Christian, Ullén, Susann, Kjaergaard, Jesper, Wise, Matt P., Horn, Janneke, Lilja, Gisela, Blennow, Kaj, Westhall, Erik, Friberg, Hans, Stammet, Pascal, Nielsen, Niklas, Backman, Sofia

2021

Overview

Purpose 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. Methods 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. Results 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. Conclusion 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.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: 33-degrees-c / Ambulance services / Anesthesiology / association / Biomarkers / Blood / Blood biomarkers / Brain / Brain Injuries / Brain injury / Cardiac arrest / Cardiac patients / cerebrospinal-fluid biomarkers / Clinical Medicine / Clinical outcomes / Comparative analysis / computed-tomography / Critical Care Medicine / Emergency Medicine / ERC / ESICM guidelines / General & Internal Medicine / Glial fibrillary acidic protein / Good neurological outcome / Guidelines / Head injuries / Heart / Heart attacks / Humans / Hydrolase / Injuries / Intensive / Intensive care / Klinisk medicin / life-sustaining therapy / Medical and Health Sciences / Medical prognosis / Medical research / Medicin och hälsovetenskap / Medicine / Medicine & Public Health / Medicine, Experimental / Neurofilament light / Neurologi / Neurology / neuron-specific enolase / Neurons / Neurophysiology / Neurosciences / Neurovetenskaper / Original / Out-of-Hospital Cardiac Arrest - therapy / Pain Medicine / Patients / Pediatrics / Phosphopyruvate Hydratase / Pneumology/Respiratory System / Prognosis / Prognostication / Prospective Studies / resuscitation / Retrospective Studies / S100b protein / Serum levels / targeted temperature management / Tau protein / Traumatic brain injury / Ubiquitin / Ubiquitin carboxy-terminal hydrolase