Decreased a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 activity and neurologic outcome in patients with successful resuscitation of out-of-hospital cardiac arrest: A prospective observational study.
The purpose of this study is to investigate the association between a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13) and neurologic outcome in patients with resuscitation of out-of-hospital cardiac arrest (R-OHCA).



A prospective observational study of adult patients with R-OHCA was conducted. Plasma activity of ADAMTS13 and inflammatory markers, an immunologic marker, and a marker of endothelial damage were measured on admission and day 2. Neurologic outcome was evaluated using the Cerebral Performance Categories on day 90.



Plasma activity of ADAMTS13 on day 2 was lower in patients with poor neurologic outcome (n = 18) than that in those with good neurologic outcome (n = 16; P = .008). It was also lower in 28-day nonsurvivors (n = 12) than in survivors (n = 21; P = .019). Soluble thrombomodulin showed a strong correlation with ADAMTS13 (P = .021). Furthermore, ADAMTS13 activity was negatively correlated with the Sequential Organ Failure Assessment score (P < .001), levels of high-mobility group box 1 (P = .028), and levels of interleukin 6 (P = .047) but positively correlated with the monocyte expression of human leukocyte antigen DR (P = .023).



Decreased ADAMTS13 activity was associated with poor neurologic outcome, high mortality, and worsened immune-inflammatory status in patients with R-OHCA. These results suggest that ADAMTS13 may have pathophysiologic relevance in postcardiac arrest syndrome.
Department of Emergency and Critical Care Medicine/Emergency Center, Tohoku University Hospital, Sendai, Japan. Electronic address: hohbey@gmail.com.
Hiroyuki
H
Ohbe
Department of Emergency and Critical Care Medicine/Emergency Center, Tohoku University Hospital, Sendai, Japan; Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: kudodaisuke8@gmail.com.
Daisuke
D
Kudo
Department of Emergency and Critical Care Medicine/Emergency Center, Osaki Citizen Hospital, Osaki, Japan. Electronic address: y-3104@yc4.so-net.ne.jp.
Satoshi
S
Yamanouchi
Department of Emergency and Critical Care Medicine/Emergency Center, Tohoku University Hospital, Sendai, Japan; Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: kussie@emergency-medicine.med.tohoku.ac.jp.
Shigeki
S
Kushimoto
D000071120:ADAMTS13 Protein / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001926:Brain Death / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000378:metabolism; D024243:HMGB1 Protein / Q000097:blood*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism; D063305:Organ Dysfunction Scores; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood / Q000150:complications / Q000628:therapy*; D018458:Persistent Vegetative State / Q000097:blood / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
D015415:Biomarkers; D006684:HLA-DR Antigens; D024243:HMGB1 Protein; C585491:HMGB1 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human
ADAMTS13; Neurologic outcome; Out-of-hospital cardiac arrest; Postcardiac arrest syndrome