title: Secretoneurin as a marker for hypoxic brain injury after cardiopulmonary resuscitation.
abstract: OBJECTIVE
  The neuropeptide secretoneurin (SN) shows widespread distribution in the brain. We evaluated whether SN is elevated after cardiopulmonary resuscitation (CPR) and could serve as a potential new biomarker for hypoxic brain injury after CPR.
  
  
  METHODS
  This was a prospective observational clinical study. All patients admitted to a tertiary medical intensive care unit after successful CPR with expected survival of at least 24 h were consecutively enrolled from September 2008 to April 2013. Serum SN and neuron-specific enolase were determined in 24 h intervals starting with the day of CPR for 7 days. Neurological outcome was assessed with the Cerebral Performance Categories Scale (CPC) at hospital discharge.
  
  
  RESULTS
  A total of 134 patients were included with 49 % surviving to good neurological outcome (CPC 1-2). SN serum levels peaked within the first 24 h showing on average a sixfold increase above normal. SN levels were significantly higher in patients with poor (CPC 3-5) than in patients with good neurological outcome [0-24 h: 75 (43-111) vs. 38 (23-68) fmol/ml, p < 0.001; 24-48 h: 45 (24-77) vs. 23 (16-39) fmol/ml, p < 0.001]. SN determined within the first 48 h showed a receiver operating characteristic (ROC) area under the curve (AUC) of 0.753 (0.665-0.841). NSE in the first 72 h had a ROC-AUC of 0.881 (0.815-0.946). When combining the two biomarkers an AUC of 0.925 (0.878-0.972) for outcome prediction could be reached.
  
  
  CONCLUSIONS
  SN is a promising early biomarker for hypoxic brain injury. Further studies will be required for confirmation of these results.
authors.affiliation: Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Hasslacher
authors.forename: Georg Franz
authors.initials: GF
authors.lastname: Lehner
authors.forename: Ulrich
authors.initials: U
authors.lastname: Harler
authors.forename: Ronny
authors.initials: R
authors.lastname: Beer
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kirchmair
authors.forename: Reiner
authors.initials: R
authors.lastname: Fischer-Colbrie
authors.forename: Romuald
authors.initials: R
authors.lastname: Bellmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Dunzendorfer
authors.forename: Michael
authors.initials: M
authors.lastname: Joannidis
mesh_terms: D018806:APACHE; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000706:statistics & numerical data*; D003943:Diagnostic Techniques, Neurological; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000150:complications / Q000628:therapy; D006801:Humans; D002534:Hypoxia, Brain / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009479:Neuropeptides / Q000097:blood*; D063305:Organ Dysfunction Scores; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood / Q000150:complications / Q000628:therapy; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D053381:Secretogranin II / Q000097:blood*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D061665:Time-to-Treatment
chemical_list: D015415:Biomarkers; D009479:Neuropeptides; D053381:Secretogranin II; C081159:secretoneurin; D010751:Phosphopyruvate Hydratase