title: CT-proAVP (copeptin), MR-proANP and Peroxiredoxin 4 after cardiac arrest: release profiles and correlation to outcome.
abstract: BACKGROUND
  Further characterization of the post-cardiac arrest syndrome (PCAS) is essential to better understand the mechanisms resulting in injury and death. We investigated serial serum concentrations of the stress hormone c-terminal provasopressin (CT-proAVP or copeptin), the cardiac biomarker MR-proANP and a biomarker of oxidation injury, Peroxiredoxin 4 (Prx4) in patients treated with mild hypothermia (MHT) after cardiac arrest, and studied their association to the PCAS and long-term outcome.
  
  
  METHODS
  Serum samples from cardiac arrest patients were collected serially: at admission, 2, 6, 12, 24, 36, 48 and 72 h after cardiac arrest. CT-proAVP, MR-proANP and Prx4 concentrations were determined and tested for association with two surrogate markers of PCAS (time to return of spontaneous circulation and circulation-SOFA score) and with cerebral performance category (CPC) at 6 months. Good outcome was defined as CPC 1 to 2.
  
  
  RESULTS
  Eighty-four patients were included. CT-proAVP, MR-proANP and Prx4 were early biomarkers with maximum concentrations soon after cardiac arrest and with a significant discriminatory ability between good and poor long-term outcome at most time points. CT-proAVP predicted a poor outcome with the highest accuracy, followed by MR-proANP and Prx4 (area under the receiving operating characteristics curve at 12 h of 0.85, 0.77 and 0.76 respectively). CT-proAVP and MR-proANP showed best correlation to the PCAS.
  
  
  CONCLUSIONS
  In 84 resuscitated patients receiving MHT after cardiac arrest, there is a significant difference in concentrations of CT-proAVP, MR-proANP and Prx4 between patients with good and poor outcome. CT-proAVP and MR-proANP have a significant correlation to surrogate markers of the PCAS.
authors.affiliation: Department of Intensive and Perioperative Care, Skåne University Hospital, Lund University, Lund, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Annborn
authors.forename: J
authors.initials: J
authors.lastname: Dankiewicz
authors.forename: N
authors.initials: N
authors.lastname: Nielsen
authors.forename: M
authors.initials: M
authors.lastname: Rundgren
authors.forename: J G
authors.initials: JG
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Hertel
authors.forename: J
authors.initials: J
authors.lastname: Struck
authors.forename: H
authors.initials: H
authors.lastname: Friberg
mesh_terms: D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006323:Heart Arrest / Q000378:metabolism* / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D054464:Peroxiredoxins / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; C048197:copeptins; C552580:midregional pro-atrial natriuretic peptide, human; D009320:Atrial Natriuretic Factor; D054464:Peroxiredoxins