title: Exploratory study of serum ubiquitin carboxyl-terminal esterase L1 and glial fibrillary acidic protein for outcome prognostication after pediatric cardiac arrest.
abstract: BACKGROUND
  Brain injury is the leading cause of morbidity and death following pediatric cardiac arrest. Serum biomarkers of brain injury may assist in outcome prognostication. The objectives of this study were to evaluate the properties of serum ubiquitin carboxyl-terminal esterase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) to classify outcome in pediatric cardiac arrest.
  
  
  METHODS
  Single center prospective study. Serum biomarkers were measured at 2 time points during the initial 72 h in children after cardiac arrest (n=19) and once in healthy children (controls, n=43). We recorded demographics and details of the cardiac arrest and resuscitation. We determined the associations between serum biomarker concentrations and Pediatric Cerebral Performance Category (PCPC) at 6 months (favorable (PCPC 1-3) or unfavorable (PCPC 4-6)).
  
  
  RESULTS
  The initial assessment (time point 1) occurred at a median (IQR) of 10.5 (5.5-17.0)h and the second assessment (time point 2) at 59.0 (54.5-65.0)h post-cardiac arrest. Serum UCH-L1 was higher among children following cardiac arrest than among controls at both time points (p<0.05). Serum GFAP in subjects with unfavorable outcome was higher at time point 2 than in controls (p<0.05). Serum UCH-L1 at time point 1 (AUC 0.782) and both UCH-L1 and GFAP at time point 2 had good classification accuracy for outcome (AUC 0.822 and 0.796), p<0.05 for all.
  
  
  CONCLUSIONS
  Preliminary data suggest that serum UCH-L1 and GFAP may be of use to prognosticate outcome after pediatric cardiac arrest at clinically-relevant time points and should be validated prospectively.
authors: Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, Pittsburgh, PA, USA. Electronic address: finkel@ccm.upmc.edu.
authors: Ericka L
authors: EL
authors: Fink
authors: Child Advocacy, Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
authors: Rachel P
authors: RP
authors: Berger
authors: Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, Pittsburgh, PA, USA.
authors: Robert S B
authors: RS
authors: Clark
authors: Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA; Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA.
authors: R Scott
authors: RS
authors: Watson
authors: Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA.
authors: Derek C
authors: DC
authors: Angus
authors: Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
authors: Ashok
authors: A
authors: Panigrahy
authors: Statistical Analysis and Measurement Consultants, Inc., Lanexa, VA, USA.
authors: Rudolph
authors: R
authors: Richichi
authors: Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, Pittsburgh, PA, USA.
authors: Clifton W
authors: CW
authors: Callaway
authors: Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, Pittsburgh, PA, USA.
authors: Michael J
authors: MJ
authors: Bell
authors: Neurosciences, University of Messina, Messina, Italy.
authors: Stefania
authors: S
authors: Mondello
authors: Banyan Labs, Banyan Biomarkers Inc., Alachua, FL, USA.
authors: Ronald L
authors: RL
authors: Hayes
authors: Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, Pittsburgh, PA, USA.
authors: Patrick M
authors: PM
authors: Kochanek
mesh_terms: D015415:Biomarkers / Q000097:blood; D001927:Brain Diseases / Q000097:blood* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006323:Heart Arrest / Q000097:blood* / Q000150:complications*; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D043222:Ubiquitin Thiolesterase / Q000097:blood*
chemical_list: D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein; C482860:UCHL1 protein, human; D043222:Ubiquitin Thiolesterase
keywords: Biomarker; Brain injury; Cardiac arrest; Outcomes; Pediatric