Usefulness of admission matrix metalloproteinase 9 as a predictor of early mortality after cardiopulmonary resuscitation in cardiac arrest patients.
BACKGROUND
Matrix metalloproteinases (MMPs) have a central role in disease progression after ischemia-reperfusion injury. However, its prognostic significance in cardiac arrest (CA) patients having cardiopulmonary resuscitation (CPR) is unknown. The aim of this study was to investigate the relation between admission MMP-9 level and early mortality in CA patients.


METHODS
A total of 96 in-hospital or out-of-hospital CA patients and 40 age- and sex-matched healthy volunteers as the control group were evaluated prospectively. The patients were classified according to the CPR response into a successful group (n = 46) and a failed group (n = 50).


RESULTS
The MMP-9 levels were detected to be 56.9 ± 4.3, 69.5 ± 7.4, and 92.7 ± 10.1 ng/mL in the control group, the successful CPR group (acute responders), and the failed CPR group, respectively (P < .001 for the 2 comparisons). The MMP-9 level on admission, presence of asystole, mean CA duration, out-of-hospital CPR, sodium and potassium levels, and arterial pH were found to have prognostic significance in univariate analysis. In addition, MMP-9 levels were correlated with age, troponin level, and oxygen saturation. In multivariate logistic regression analysis with forward stepwise method, only MMP-9 level on admission (odds ratio, 1.504; P < .001) and mean CA duration before CPR (odds ratio, 1.257; P = .019) remained associated with post-CPR early mortality after adjustment of other potential confounders. In addition, optimal cutoff value of MMP-9 to predict failed CPR was found as greater than 82 ng/mL, with 88% sensitivity and 97.8% specificity.


CONCLUSIONS
High MMP-9 levels were associated with worse clinical and laboratory parameters, and it seems that MMP-9 helps risk stratification in CA patients.
Department of Emergency, Cumhuriyet University Medical School, Sivas, Turkey.
Kenan Ahmet
KA
Turkdogan
Ali
A
Zorlu
Fatma Mutlu Kukul
FM
Guven
Ismail
I
Ekinozu
Umut
U
Eryigit
Mehmet Birhan
MB
Yilmaz
D000368:Aged; D015415:Biomarkers / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000401:mortality; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity
D015415:Biomarkers; D020780:Matrix Metalloproteinase 9