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Postanoxic electrographic status epilepticus and serum biomarkers of brain injury

Lybeck, Anna LU orcid ; Friberg, Hans LU ; Nielsen, Niklas LU ; Rundgren, Malin LU ; Ullén, Susann LU ; Zetterberg, Henrik LU ; Blennow, Kaj LU ; Cronberg, Tobias LU and Westhall, Erik LU (2021) In Resuscitation 158. p.253-257
Abstract

Aim: To explore if electrographic status epilepticus (ESE) after cardiac arrest causes additional secondary brain injury reflected by serum levels of two novel biomarkers of brain injury: neurofilament light chain (NfL) originating from neurons and glial fibrillary acidic protein (GFAP) from glial cells. Methods: Simplified continuous EEG (cEEG) and serum levels of NfL and GFAP, sampled at 24, 48 and 72 h after cardiac arrest, were collected during the Target Temperature Management (TTM)-trial. Two statistical methods were used: multivariable regresssion analysis; and a matched control group of patients without ESE matched for early predictors of poor neurological outcome. Results: 128 patients had available biomarkers and cEEG.... (More)

Aim: To explore if electrographic status epilepticus (ESE) after cardiac arrest causes additional secondary brain injury reflected by serum levels of two novel biomarkers of brain injury: neurofilament light chain (NfL) originating from neurons and glial fibrillary acidic protein (GFAP) from glial cells. Methods: Simplified continuous EEG (cEEG) and serum levels of NfL and GFAP, sampled at 24, 48 and 72 h after cardiac arrest, were collected during the Target Temperature Management (TTM)-trial. Two statistical methods were used: multivariable regresssion analysis; and a matched control group of patients without ESE matched for early predictors of poor neurological outcome. Results: 128 patients had available biomarkers and cEEG. Twenty-six (20%) patients developed ESE, the majority (69%) within 24 h. ESE was an independent predictor of elevated serum NfL (p < 0.001) but not of serum GFAP (p = 0.16) at 72 h after cardiac arrest. Compared to a control group matched for early predictors of poor neurological outcome, patients who developed ESE had higher levels of serum NfL (p = 0.03) and GFAP (p = 0.04) at 72 h after cardiac arrest. Conclusion: ESE after cardiac arrest is associated with higher levels of serum NfL which may suggest increased secondary neuronal injury compared to matched patients without ESE but similar initial brain injury. Associations with GFAP reflecting glial injury are less clear. The study design cannot exclude imperfect matching or other mechanisms of secondary brain injury contributing to the higher levels of biomarkers of brain injury seen in the patients with ESE.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Biomarkers, Cardiac arrest, EEG, Electrographic status epilepticus, Seizures
in
Resuscitation
volume
158
pages
5 pages
publisher
Elsevier
external identifiers
  • pmid:33127439
  • scopus:85094896888
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2020.10.027
language
English
LU publication?
yes
id
15df932b-bd5e-436f-a255-e3ced71e5943
date added to LUP
2020-11-23 07:42:27
date last changed
2024-04-17 19:53:59
@article{15df932b-bd5e-436f-a255-e3ced71e5943,
  abstract     = {{<p>Aim: To explore if electrographic status epilepticus (ESE) after cardiac arrest causes additional secondary brain injury reflected by serum levels of two novel biomarkers of brain injury: neurofilament light chain (NfL) originating from neurons and glial fibrillary acidic protein (GFAP) from glial cells. Methods: Simplified continuous EEG (cEEG) and serum levels of NfL and GFAP, sampled at 24, 48 and 72 h after cardiac arrest, were collected during the Target Temperature Management (TTM)-trial. Two statistical methods were used: multivariable regresssion analysis; and a matched control group of patients without ESE matched for early predictors of poor neurological outcome. Results: 128 patients had available biomarkers and cEEG. Twenty-six (20%) patients developed ESE, the majority (69%) within 24 h. ESE was an independent predictor of elevated serum NfL (p &lt; 0.001) but not of serum GFAP (p = 0.16) at 72 h after cardiac arrest. Compared to a control group matched for early predictors of poor neurological outcome, patients who developed ESE had higher levels of serum NfL (p = 0.03) and GFAP (p = 0.04) at 72 h after cardiac arrest. Conclusion: ESE after cardiac arrest is associated with higher levels of serum NfL which may suggest increased secondary neuronal injury compared to matched patients without ESE but similar initial brain injury. Associations with GFAP reflecting glial injury are less clear. The study design cannot exclude imperfect matching or other mechanisms of secondary brain injury contributing to the higher levels of biomarkers of brain injury seen in the patients with ESE.</p>}},
  author       = {{Lybeck, Anna and Friberg, Hans and Nielsen, Niklas and Rundgren, Malin and Ullén, Susann and Zetterberg, Henrik and Blennow, Kaj and Cronberg, Tobias and Westhall, Erik}},
  issn         = {{0300-9572}},
  keywords     = {{Biomarkers; Cardiac arrest; EEG; Electrographic status epilepticus; Seizures}},
  language     = {{eng}},
  month        = {{01}},
  pages        = {{253--257}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Postanoxic electrographic status epilepticus and serum biomarkers of brain injury}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2020.10.027}},
  doi          = {{10.1016/j.resuscitation.2020.10.027}},
  volume       = {{158}},
  year         = {{2021}},
}