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Plasma phosphorylated tau (p-tau231) and total tau (t-tau) as prognostic markers of neurological outcome after cardiac arrest - a multicentre study

Þorgeirsdóttir, Bergþóra LU orcid ; Sievert, Theodor LU orcid ; Lybeck, Anna LU orcid ; Ashton, Nicholas J. ; Blennow, Kaj LU ; Zetterberg, Henrik LU ; Friberg, Hans LU and Frigyesi, Attila LU (2025) In Resuscitation 206.
Abstract
Purpose
We studied the promising Alzheimer biomarker plasma tau phosphorylated at threonine 231 (p-tau231) in a cohort of cardiac arrest patients who survived to intensive care to predict long-term neurological outcomes. We also compared it to total tau (t-tau), which has demonstrated predictive abilities of neurological outcome post-cardiac arrest.
Methods
This observational multicentre cohort study included 425 patients admitted to intensive care after cardiac arrest. Plasma p-tau231 was retrospectively analysed at admission, 12 and 48 h after cardiac arrest. The association of the Cerebral Performance Category (CPC) with p-tau231 was analysed with a one-way analysis of variance (ANOVA). CPC was modelled using multivariate... (More)
Purpose
We studied the promising Alzheimer biomarker plasma tau phosphorylated at threonine 231 (p-tau231) in a cohort of cardiac arrest patients who survived to intensive care to predict long-term neurological outcomes. We also compared it to total tau (t-tau), which has demonstrated predictive abilities of neurological outcome post-cardiac arrest.
Methods
This observational multicentre cohort study included 425 patients admitted to intensive care after cardiac arrest. Plasma p-tau231 was retrospectively analysed at admission, 12 and 48 h after cardiac arrest. The association of the Cerebral Performance Category (CPC) with p-tau231 was analysed with a one-way analysis of variance (ANOVA). CPC was modelled using multivariate ordinal logistic regression, and the biomarkers’ prognostic performance was assessed by the area under the receiver operating characteristic curve (AUC).
Results
Increasing p-tau231 levels were significantly associated with worse CPC (p < 0.001). P-tau231 showed moderate prognostic abilities (AUC: 0.69 on admission, 0.72 at 12 h, and 0.71 at 48 h) for all patients but did not improve neurological prognostication after adjusting for clinical covariates. Elevated levels of t-tau were significantly associated with a worse outcome at all time points (p < 0.001). T-tau significantly improved neurological prognosis at 48 h after adjusting for covariates (AUC: 0.95, 95 % CI 0.93–0.98, p < 0.001) compared to the clinical covariate reference model (AUC: 0.88, 95 % CI 0.84–0.93).
Conclusions
Although p-tau231 showed moderate neurological prognostic ability, t-tau was a stronger predictor, particularly at 48 h, even after adjusting for clinical covariates. (Less)
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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Tau phosphorylated at threonine 231 (p-tau231), Total Tau (t-tau), Cardiac arrest, Intensive care, Critical care, Prognostication
in
Resuscitation
volume
206
article number
110450
publisher
Elsevier
external identifiers
  • scopus:85211195432
  • pmid:39637966
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2024.110450
language
English
LU publication?
yes
id
033b6cd6-d9e8-47dc-abcf-e465f8b8aa1d
date added to LUP
2024-12-05 22:36:35
date last changed
2025-04-04 15:15:49
@article{033b6cd6-d9e8-47dc-abcf-e465f8b8aa1d,
  abstract     = {{Purpose<br/>We studied the promising Alzheimer biomarker plasma tau phosphorylated at threonine 231 (p-tau231) in a cohort of cardiac arrest patients who survived to intensive care to predict long-term neurological outcomes. We also compared it to total tau (t-tau), which has demonstrated predictive abilities of neurological outcome post-cardiac arrest.<br/>Methods<br/>This observational multicentre cohort study included 425 patients admitted to intensive care after cardiac arrest. Plasma p-tau231 was retrospectively analysed at admission, 12 and 48 h after cardiac arrest. The association of the Cerebral Performance Category (CPC) with p-tau231 was analysed with a one-way analysis of variance (ANOVA). CPC was modelled using multivariate ordinal logistic regression, and the biomarkers’ prognostic performance was assessed by the area under the receiver operating characteristic curve (AUC).<br/>Results<br/>Increasing p-tau231 levels were significantly associated with worse CPC (p &lt; 0.001). P-tau231 showed moderate prognostic abilities (AUC: 0.69 on admission, 0.72 at 12 h, and 0.71 at 48 h) for all patients but did not improve neurological prognostication after adjusting for clinical covariates. Elevated levels of t-tau were significantly associated with a worse outcome at all time points (p &lt; 0.001). T-tau significantly improved neurological prognosis at 48 h after adjusting for covariates (AUC: 0.95, 95 % CI 0.93–0.98, p &lt; 0.001) compared to the clinical covariate reference model (AUC: 0.88, 95 % CI 0.84–0.93).<br/>Conclusions<br/>Although p-tau231 showed moderate neurological prognostic ability, t-tau was a stronger predictor, particularly at 48 h, even after adjusting for clinical covariates.}},
  author       = {{Þorgeirsdóttir, Bergþóra and Sievert, Theodor and Lybeck, Anna and Ashton, Nicholas J. and Blennow, Kaj and Zetterberg, Henrik and Friberg, Hans and Frigyesi, Attila}},
  issn         = {{0300-9572}},
  keywords     = {{Tau phosphorylated at threonine 231 (p-tau231); Total Tau (t-tau); Cardiac arrest; Intensive care; Critical care; Prognostication}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Plasma phosphorylated tau (p-tau231) and total tau (t-tau) as prognostic markers of neurological outcome after cardiac arrest - a multicentre study}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2024.110450}},
  doi          = {{10.1016/j.resuscitation.2024.110450}},
  volume       = {{206}},
  year         = {{2025}},
}