Cerebrospinal fluid biomarkers in cardiac arrest survivors.
OBJECTIVE
The aim of this study was to investigate the levels of various cerebrospinal fluid (CSF) biomarkers related to neuronal damage, inflammation and amyloid β (Aβ) metabolism in patients resuscitated after an out-of-hospital cardiac arrest (CA).


METHODS
CSF levels of neurofilament light protein (NFL), total tau (T-tau), hyperphosphorylated tau (P-tau), YKL-40, Aβ38, Aβ40, Aβ42, soluble amyloid precursor protein α and β (sAPPα and sAPPβ) were measured in 21 patients approximately two weeks after CA and in 21 age-matched neurologically healthy controls. The biomarker levels were also compared between patients with good and poor long-term clinical outcome according to Glasgow Outcome Scale (GOS), activities of daily living (ADL) and mini-mental state examination (MMSE), measuring neurologic function, daily functioning and cognitive function, respectively.


RESULTS
Patients with CA had a very marked increase in the CSF levels of NFL, T-tau and YKL-40 as compared with controls. The levels were increased at about 1200, 700 and 100%, respectively. NFL and T-tau were significantly higher in patients with poor outcome according to all three outcome measures. Patients with poor outcome according to GOS and ADL had higher levels of YKL-40. Levels of Aβ38, Aβ40, Aβ42, sAPPα and sAPPβ were lower in patients with a low MMSE score. P-tau was not significantly altered.


CONCLUSIONS
Biomarkers reflecting neuronal damage and inflammation, but not so much Aβ metabolism, were significantly altered in patients after a CA, and the changes were more pronounced in the groups with poor outcome. This calls for future larger studies to determine the prognostic potential of these biomarkers.
Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden. Electronic address: christoffer.rosen@neuro.gu.se.
Christoffer
C
Rosén
Institute of Clinical Neuroscience, Department of Neurology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: hans.rosen@neuro.gu.se.
Hans
H
Rosén
Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden. Electronic address: ulf.andreasson@neuro.gu.se.
Ulf
U
Andreasson
Department of Infectious Medicine, Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: daniel.bremell@infect.gu.se.
Daniel
D
Bremell
Karlstad Hospital, Karlstad, Sweden. Electronic address: rosemarybremler@gmail.com.
Rosemary
R
Bremler
Department of Infectious Medicine, Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: lars.hagberg@medfak.gu.se.
Lars
L
Hagberg
Institute of Clinical Neuroscience, Department of Neurology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: lars.rosengren@neuro.gu.se.
Lars
L
Rosengren
Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden. Electronic address: kaj.blennow@neuro.gu.se.
Kaj
K
Blennow
Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden; UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom. Electronic address: henrik.zetterberg@clinchem.gu.se.
Henrik
H
Zetterberg
D000203:Activities of Daily Living; D016229:Amyloid beta-Peptides / Q000134:cerebrospinal fluid; D015415:Biomarkers / Q000134:cerebrospinal fluid*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007249:Inflammation / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D016900:Neurofilament Proteins / Q000134:cerebrospinal fluid; D058687:Out-of-Hospital Cardiac Arrest / Q000134:cerebrospinal fluid*; D017741:Survivors; D016875:tau Proteins / Q000134:cerebrospinal fluid
D016229:Amyloid beta-Peptides; D015415:Biomarkers; D016900:Neurofilament Proteins; C044882:neurofilament protein L; D016875:tau Proteins
Biomarkers; Cardiac arrest; Cerebrospinal fluid; Outcome