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

Authors
  • Moseby-Knappe, Marion
  • Mattsson-Carlgren, Niklas
  • Stammet, Pascal
  • Backman, Sofia
  • Blennow, Kaj
  • Dankiewicz, Josef
  • Friberg, Hans
  • Hassager, Christian
  • Horn, Janneke
  • Kjaergaard, Jesper
  • Lilja, Gisela
  • Rylander, Christian
  • Ullén, Susann
  • Undén, Johan
  • Westhall, Erik
  • Wise, Matt P.
  • Zetterberg, Henrik
  • Nielsen, Niklas
  • Cronberg, Tobias
Type
Published Article
Journal
Intensive Care Medicine
Publisher
Springer Berlin Heidelberg
Publication Date
Aug 21, 2021
Volume
47
Issue
9
Pages
984–994
Identifiers
DOI: 10.1007/s00134-021-06481-4
PMID: 34417831
PMCID: PMC8421280
Source
PubMed Central
Keywords
Disciplines
  • Original
License
Unknown

Abstract

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. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06481-4.

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