title: The Combination of Biomarkers for Prognostication of Long-Term Outcome in Patients Treated with Mild Hypothermia After Out-of-Hospital Cardiac Arrest-A Pilot Study.
abstract: To explore if the brain biomarker neuron-specific enolase (NSE) in combination with a biomarker for stress; CT-proAVP (copeptin), oxidation; peroxiredoxin 4 (Prx4), inflammation; procalcitonin (PCT), or with biomarkers from the heart; midregional proatrial natriuretic peptide (MR-proANP), or troponin T (TnT) can improve the prognostic accuracy of long-term outcome after out-of-hospital cardiac arrest (OHCA). Serum samples from cardiac arrest patients, treated at 33°C for 24 hours, were collected serially at 12, 24, and 48 hours after cardiac arrest. The concentration of the investigated biomarkers was measured using stored samples, and long-term outcome was evaluated by the cerebral performance category (CPC) at 6 months. Poor outcome was defined as CPC 3-5. Sixty-two patients with OHCA of presumed cardiac cause were included. NSE had best prognostic accuracy for poor outcome at 48 hours with a receiver operating characteristic area under curve (AUC) of 0.94 (95% confidence interval [CI] 0.87-1). The combination of NSE with TnT, both at 48 hours, increased the AUC to 0.98 (95% CI 0.95-1, likelihood ratio [LR] test p-value 0.07, net reclassification index [NRI] <0.001); NSE and MR-proANP, both at 12 hours, yielded an AUC of 0.91 (95% CI 0.80-1, LR test p-value 0.0014, NRI p-value 0.003); NSE at 48 hours with MR-proANP at 12 hours yielded an AUC of 0.97 (95% CI 0.92-1, LR test p-value 0.055, NRI p-value 0.04). This pilot study suggests that a combination of biomarkers with NSE could be beneficial for improving early prognostication of long-term outcome following OHCA.
authors.affiliation: 1 Department of Anesthesia and Intensive Care, Helsingborg General Hospital , Helsingborg, Sweden .|2 Department of Clinical Sciences, Lund University , Lund, Sweden .
authors.forename: Martin
authors.initials: M
authors.lastname: Annborn
authors.affiliation: 2 Department of Clinical Sciences, Lund University , Lund, Sweden .|3 R&D Centre Skåne, Skåne University Hospital , Lund, Sweden .
authors.forename: Fredrik
authors.initials: F
authors.lastname: Nilsson
authors.affiliation: 2 Department of Clinical Sciences, Lund University , Lund, Sweden .|4 Department of Intensive and Perioperative Care, Skåne University Hospital , Lund, Sweden .
authors.forename: Josef
authors.initials: J
authors.lastname: Dankiewicz
authors.affiliation: 2 Department of Clinical Sciences, Lund University , Lund, Sweden .|4 Department of Intensive and Perioperative Care, Skåne University Hospital , Lund, Sweden .
authors.forename: Malin
authors.initials: M
authors.lastname: Rundgren
authors.affiliation: 5 Thermo Fisher Scientific BRAHMS , Clinical Diagnostics, Hennigsdorf, Germany .
authors.forename: Sabine
authors.initials: S
authors.lastname: Hertel
authors.affiliation: 6 Adrenomed AG , Hennigsdorf, Germany .
authors.forename: Joachim
authors.initials: J
authors.lastname: Struck
authors.affiliation: 2 Department of Clinical Sciences, Lund University , Lund, Sweden .|7 Division of Neurology, Skåne University Hospital, Lund, Sweden .
authors.forename: Tobias
authors.initials: T
authors.lastname: Cronberg
authors.affiliation: 1 Department of Anesthesia and Intensive Care, Helsingborg General Hospital , Helsingborg, Sweden .|2 Department of Clinical Sciences, Lund University , Lund, Sweden .
authors.forename: Niklas
authors.initials: N
authors.lastname: Nielsen
mesh_terms: D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D006020:Glycopeptides / Q000097:blood; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods; D000069451:Long Term Adverse Effects / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy; D054464:Peroxiredoxins / Q000097:blood; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D020107:Troponin T; C048197:copeptins; C552580:midregional pro-atrial natriuretic peptide, human; D009320:Atrial Natriuretic Factor; D054464:Peroxiredoxins; D010751:Phosphopyruvate Hydratase