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Plasma glial fibrillary acidic protein and tau : predictors of neurological outcome after cardiac arrest

Arctaedius, Isabelle LU ; Levin, Helena LU ; Thorgeirsdóttir, Bergthóra LU orcid ; Moseby-Knappe, Marion LU ; Cronberg, Tobias LU ; Annborn, Martin LU ; Nielsen, Niklas LU ; Zetterberg, Henrik LU ; Blennow, Kaj LU and Ashton, Nicholas J. , et al. (2024) In Critical Care 28(1).
Abstract

Background: The purpose was to evaluate glial fibrillary acidic protein (GFAP) and total-tau in plasma as predictors of poor neurological outcome after out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA), including comparisons with neurofilament light (NFL) and neuron-specific enolase (NSE). Methods: Retrospective multicentre observational study of patients admitted to an intensive care unit (ICU) in three hospitals in Sweden 2014–2018. Blood samples were collected at ICU admission, 12 h, and 48 h post-cardiac arrest. Poor neurological outcome was defined as Cerebral Performance Category 3–5 at 2–6 months after cardiac arrest. Plasma samples were retrospectively analysed for GFAP, tau, and NFL. Serum NSE was analysed in... (More)

Background: The purpose was to evaluate glial fibrillary acidic protein (GFAP) and total-tau in plasma as predictors of poor neurological outcome after out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA), including comparisons with neurofilament light (NFL) and neuron-specific enolase (NSE). Methods: Retrospective multicentre observational study of patients admitted to an intensive care unit (ICU) in three hospitals in Sweden 2014–2018. Blood samples were collected at ICU admission, 12 h, and 48 h post-cardiac arrest. Poor neurological outcome was defined as Cerebral Performance Category 3–5 at 2–6 months after cardiac arrest. Plasma samples were retrospectively analysed for GFAP, tau, and NFL. Serum NSE was analysed in clinical care. Prognostic performances were tested with the area under the receiver operating characteristics curve (AUC). Results: Of the 428 included patients, 328 were OHCA, and 100 were IHCA. At ICU admission, 12 h and 48 h post-cardiac arrest, GFAP predicted neurological outcome after OHCA with AUC (95% CI) 0.76 (0.70–0.82), 0.86 (0.81–0.90) and 0.91 (0.87–0.96), and after IHCA with AUC (95% CI) 0.77 (0.66–0.87), 0.83 (0.74–0.92) and 0.83 (0.71–0.95). At the same time points, tau predicted outcome after OHCA with AUC (95% CI) 0.72 (0.66–0.79), 0.75 (0.69–0.81), and 0.93 (0.89–0.96) and after IHCA with AUC (95% CI) 0.61 (0.49–0.74), 0.68 (0.56–0.79), and 0.77 (0.65–0.90). Adding the change in biomarker levels between time points did not improve predictive accuracy compared to the last time point. In a subset of patients, GFAP at 12 h and 48 h, as well as tau at 48 h, offered similar predictive value as NSE at 48 h (the earliest time point NSE is recommended in guidelines) after both OHCA and IHCA. The predictive performance of NFL was similar or superior to GFAP and tau at all time points after OHCA and IHCA. Conclusion: GFAP and tau are promising biomarkers for neuroprognostication, with the highest predictive performance at 48 h after OHCA, but not superior to NFL. The predictive ability of GFAP may be sufficiently high for clinical use at 12 h after cardiac arrest.

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type
Contribution to journal
publication status
published
subject
keywords
Biomarkers, GFAP, Heart arrest, In-hospital cardiac arrest, Out-of-hospital cardiac arrest, Prognostication, Tau
in
Critical Care
volume
28
issue
1
article number
116
publisher
BioMed Central (BMC)
external identifiers
  • pmid:38594704
  • scopus:85189977893
ISSN
1364-8535
DOI
10.1186/s13054-024-04889-0
language
English
LU publication?
yes
id
1bf40d90-f72f-40fd-ab34-39c03343b1bd
date added to LUP
2024-04-23 14:44:32
date last changed
2024-05-07 16:10:17
@article{1bf40d90-f72f-40fd-ab34-39c03343b1bd,
  abstract     = {{<p>Background: The purpose was to evaluate glial fibrillary acidic protein (GFAP) and total-tau in plasma as predictors of poor neurological outcome after out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA), including comparisons with neurofilament light (NFL) and neuron-specific enolase (NSE). Methods: Retrospective multicentre observational study of patients admitted to an intensive care unit (ICU) in three hospitals in Sweden 2014–2018. Blood samples were collected at ICU admission, 12 h, and 48 h post-cardiac arrest. Poor neurological outcome was defined as Cerebral Performance Category 3–5 at 2–6 months after cardiac arrest. Plasma samples were retrospectively analysed for GFAP, tau, and NFL. Serum NSE was analysed in clinical care. Prognostic performances were tested with the area under the receiver operating characteristics curve (AUC). Results: Of the 428 included patients, 328 were OHCA, and 100 were IHCA. At ICU admission, 12 h and 48 h post-cardiac arrest, GFAP predicted neurological outcome after OHCA with AUC (95% CI) 0.76 (0.70–0.82), 0.86 (0.81–0.90) and 0.91 (0.87–0.96), and after IHCA with AUC (95% CI) 0.77 (0.66–0.87), 0.83 (0.74–0.92) and 0.83 (0.71–0.95). At the same time points, tau predicted outcome after OHCA with AUC (95% CI) 0.72 (0.66–0.79), 0.75 (0.69–0.81), and 0.93 (0.89–0.96) and after IHCA with AUC (95% CI) 0.61 (0.49–0.74), 0.68 (0.56–0.79), and 0.77 (0.65–0.90). Adding the change in biomarker levels between time points did not improve predictive accuracy compared to the last time point. In a subset of patients, GFAP at 12 h and 48 h, as well as tau at 48 h, offered similar predictive value as NSE at 48 h (the earliest time point NSE is recommended in guidelines) after both OHCA and IHCA. The predictive performance of NFL was similar or superior to GFAP and tau at all time points after OHCA and IHCA. Conclusion: GFAP and tau are promising biomarkers for neuroprognostication, with the highest predictive performance at 48 h after OHCA, but not superior to NFL. The predictive ability of GFAP may be sufficiently high for clinical use at 12 h after cardiac arrest.</p>}},
  author       = {{Arctaedius, Isabelle and Levin, Helena and Thorgeirsdóttir, Bergthóra and Moseby-Knappe, Marion and Cronberg, Tobias and Annborn, Martin and Nielsen, Niklas and Zetterberg, Henrik and Blennow, Kaj and Ashton, Nicholas J. and Frigyesi, Attila and Friberg, Hans and Lybeck, Anna and Mattsson-Carlgren, Niklas}},
  issn         = {{1364-8535}},
  keywords     = {{Biomarkers; GFAP; Heart arrest; In-hospital cardiac arrest; Out-of-hospital cardiac arrest; Prognostication; Tau}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Critical Care}},
  title        = {{Plasma glial fibrillary acidic protein and tau : predictors of neurological outcome after cardiac arrest}},
  url          = {{http://dx.doi.org/10.1186/s13054-024-04889-0}},
  doi          = {{10.1186/s13054-024-04889-0}},
  volume       = {{28}},
  year         = {{2024}},
}