Plasma concentrations of von Willebrand factor and intracellular adhesion molecule-1 for prediction of outcome after successful cardiopulmonary resuscitation.
OBJECTIVE
Ischemia/reoxygenation following cardiopulmonary resuscitation might cause endothelial injury/activation that could contribute to an adverse outcome after cardiopulmonary resuscitation. We studied plasma concentrations of von Willebrand factor (vWF) antigen and soluble intracellular adhesion molecule (sICAM)-1 as markers of a generalized endothelial injury/activation in relation to outcome after cardiopulmonary resuscitation.


METHODS
Retrospective study on stored plasma samples.


METHODS
Intensive care unit at a university hospital.


METHODS
Thirty-five patients who survived >24 hrs after in- or out-of-hospital cardiopulmonary resuscitation and 15 noncritically ill control patients.I NTERVENTIONS: Blood sampling.


RESULTS
Plasma concentrations of vWF antigen and sICAM-1 on day 2 after cardiopulmonary resuscitation were higher in patients than in controls (p < .001 and p = .001, respectively). In-hospital cardiopulmonary resuscitation, cardiopulmonary resuscitation duration > or = 15 mins, severe cardiovascular failure, and renal dysfunction/failure at the time of blood sampling were associated with significant elevations in vWF antigen and sICAM-1 concentrations. Patients with an unfavorable outcome after cardiopulmonary resuscitation (cerebral performance category > or = 3) exhibited higher vWF antigen and sICAM-1 concentrations than patients with good outcome (cerebral performance category 1-2; p < .001 and p = .097, respectively). Renal dysfunction/failure, severe cardiovascular failure, systemic inflammatory response syndrome, and cardiopulmonary resuscitation duration > or = 15 mins were also associated with higher adverse outcome rates. Combination of these four variables into a cardiac arrest risk score (levels 0-4) showed adverse outcome rates of 100, 56, and 0% in patients with arrest scores of 4, 2-3, and 0-1, respectively. A vWF antigen concentration >166% was an independent predictor of outcome after cardiopulmonary resuscitation (p = .002) and was associated with increased adverse outcome rates in patients with cardiac arrest risk scores of 2-3. Furthermore, both vWF antigen concentrations >166% and sICAM-1 concentrations >500 ng/mL had 100% specificity for an adverse outcome in patients after out-of-hospital cardiopulmonary resuscitation but were less predictive in patients after in-hospital cardiopulmonary resuscitation.


CONCLUSIONS
vWF antigen and sICAM-1 might be useful adjunctive variables for early determination of outcome in patients after successful out-of-hospital cardiopulmonary resuscitation.
Geppert
Alexander
A
Department of Cardiology, University of Vienna, Austria.
Zorn
Gerlinde
G
Delle-Karth
Georg
G
Koreny
Maria
M
Siostrzonek
Peter
P
Heinz
Gottfried
G
Huber
Kurt
K
D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D006323:Heart Arrest / Q000150:complications / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D016015:Logistic Models; D009102:Multiple Organ Failure / Q000209:etiology; D015428:Myocardial Reperfusion Injury / Q000097:blood* / Q000209:etiology* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014841:von Willebrand Factor / Q000378:metabolism*
D015415:Biomarkers; D014841:von Willebrand Factor; D018799:Intercellular Adhesion Molecule-1