title: Serum Neutrophil Gelatinase-Associated Lipocalin Predicts Survival After Resuscitation From Cardiac Arrest.
abstract: OBJECTIVE
  In the first days after cardiac arrest, accurate prognostication is challenging. Serum biomarkers are a potentially attractive adjunct for prognostication and risk stratification. Our primary objective in this exploratory study was to identify novel early serum biomarkers that predict survival after cardiac arrest earlier than currently possible.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  A single academic medical center.
  
  
  METHODS
  Adult subjects who sustained cardiac arrest with return of spontaneous circulation.
  
  
  METHODS
  None.
  
  
  RESULTS
  We obtained blood samples from each subject at enrollment, 6, 12, 24, 48, and 72 hours after return of spontaneous circulation. We measured the serum levels of novel biomarkers, including neutrophil gelatinase-associated lipocalin, high-mobility group protein B1, intracellular cell adhesion molecule-1, and leptin, as well as previously characterized biomarkers, including neuron-specific enolase and S100B protein. Our primary outcome of interest was survival-to-hospital discharge. We compared biomarker concentrations at each time point between survivors and nonsurvivors and used logistic regression to test the unadjusted associations of baseline clinical characteristics and enrollment biomarker levels with survival. Finally, we constructed a series of adjusted models to explore the independent association of each enrollment biomarker level with survival. A total of 86 subjects were enrolled. Enrollment levels of high-mobility group protein B1, neutrophil gelatinase-associated lipocalin, and S100B were higher in nonsurvivors than survivors. Enrollment leptin, neuron-specific enolase, and intracellular cell adhesion molecule-1 levels did not differ between nonsurvivors and survivors. The discriminatory power of enrollment neutrophil gelatinase-associated lipocalin level was the greatest (c-statistic, 0.78 [95% CI, 0.66-0.90]) and remained stable across all time points. In our adjusted models, enrollment neutrophil gelatinase-associated lipocalin level was independently associated with survival even after controlling for the development of acute kidney injury, and its addition to clinical models improved overall predictive accuracy.
  
  
  CONCLUSIONS
  Serum neutrophil gelatinase-associated lipocalin levels are strongly predictive of survival-to-hospital discharge after cardiac arrest.
authors.affiliation: 1Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.2Department of Emergency Medicine, University of Pittsburgh, Pittsburgh PA.3Department of Biostatistics, University of Pittsburgh, Pittsburgh PA.4Department of Medicine, University of Pittsburgh, Pittsburgh PA.5Center for Research on Health Care, University of Pittsburgh, Pittsburgh PA.6Center for Critical Care Nephrology, CRISMA, University of Pittsburgh, PA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Elmer
authors.forename: Kwonho
authors.initials: K
authors.lastname: Jeong
authors.forename: Kaleab Z
authors.initials: KZ
authors.lastname: Abebe
authors.forename: Francis X
authors.initials: FX
authors.lastname: Guyette
authors.forename: Raghavan
authors.initials: R
authors.lastname: Murugan
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.forename: Jon C
authors.initials: JC
authors.lastname: Rittenberger
mesh_terms: D000209:Acute-Phase Proteins; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D015996:Survival Rate
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins