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Open Access 01-09-2021 | Temperature Management | Original

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

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

Published in: Intensive Care Medicine | Issue 9/2021

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.

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Title: Serum markers of brain injury can predict good neurological outcome after out-of-hospital cardiac arrest
Authors: Marion Moseby-Knappe
Niklas Mattsson-Carlgren
Pascal Stammet
Sofia Backman
Kaj Blennow
Josef Dankiewicz
Hans Friberg
Christian Hassager
Janneke Horn
Jesper Kjaergaard
Gisela Lilja
Christian Rylander
Susann Ullén
Johan Undén
Erik Westhall
Matt P. Wise
Henrik Zetterberg
Niklas Nielsen
Tobias Cronberg
Publication date: 01-09-2021
Publisher: Springer Berlin Heidelberg
Keywords: Temperature Management
Biomarkers
Published in: Intensive Care Medicine / Issue 9/2021
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-021-06481-4

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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