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Serum GFAP and UCH-L1 for the prediction of neurological outcome in comatose cardiac arrest patients

Ebner, Florian LU ; Moseby-Knappe, Marion LU ; Mattsson-Carlgren, Niklas LU ; Lilja, Gisela LU ; Dragancea, Irina LU ; Undén, Johan LU ; Friberg, Hans LU ; Erlinge, David LU ; Kjaergaard, Jesper and Hassager, Christian , et al. (2020) In Resuscitation 154. p.61-68
Abstract

Objective: Neurological outcome prediction is crucial early after cardiac arrest. Serum biomarkers released from brain cells after hypoxic-ischaemic injury may aid in outcome prediction. The only serum biomarker presently recommended in the European Resuscitation Council prognostication guidelines is neuron-specific enolase (NSE), but NSE has limitations. In this study, we therefore analyzed the outcome predictive accuracy of the serum biomarkers glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) in patients after cardiac arrest. Methods: Serum GFAP and UCH-L1 were collected at 24, 48 and 72 h after cardiac arrest. The primary outcome was neurological function at 6-month follow-up assessed by the... (More)

Objective: Neurological outcome prediction is crucial early after cardiac arrest. Serum biomarkers released from brain cells after hypoxic-ischaemic injury may aid in outcome prediction. The only serum biomarker presently recommended in the European Resuscitation Council prognostication guidelines is neuron-specific enolase (NSE), but NSE has limitations. In this study, we therefore analyzed the outcome predictive accuracy of the serum biomarkers glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) in patients after cardiac arrest. Methods: Serum GFAP and UCH-L1 were collected at 24, 48 and 72 h after cardiac arrest. The primary outcome was neurological function at 6-month follow-up assessed by the cerebral performance category scale (CPC), dichotomized into good (CPC1-2) and poor (CPC3-5). Prognostic accuracies were tested with receiver-operating characteristics by calculating the area under the receiver-operating curve (AUROC) and compared to the AUROC of NSE. Results: 717 patients were included in the study. GFAP and UCH-L1 discriminated between good and poor neurological outcome at all time-points when used alone (AUROC GFAP 0.88–0.89; UCH-L1 0.85–0.87) or in combination (AUROC 0.90–0.91). The combined model was superior to GFAP and UCH-L1 separately and NSE (AUROC 0.75–0.85) at all time-points. At specificities ≥95%, the combined model predicted poor outcome with a higher sensitivity than NSE at 24 h and with similar sensitivities at 48 and 72 h. Conclusion: GFAP and UCH-L1 predicted poor neurological outcome with high accuracy. Their combination may be of special interest for early prognostication after cardiac arrest where it performed significantly better than the currently recommended biomarker NSE.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Neurological outcome prognostication, Out-of-hospital cardiac arrest, Serum biomarkers of neurological injury
in
Resuscitation
volume
154
pages
61 - 68
publisher
Elsevier
external identifiers
  • pmid:32445783
  • scopus:85085914871
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2020.05.016
language
English
LU publication?
yes
id
4ee947f6-7887-4310-8a73-c3cdfa56b990
date added to LUP
2020-11-06 11:43:23
date last changed
2021-05-25 02:26:11
@article{4ee947f6-7887-4310-8a73-c3cdfa56b990,
  abstract     = {<p>Objective: Neurological outcome prediction is crucial early after cardiac arrest. Serum biomarkers released from brain cells after hypoxic-ischaemic injury may aid in outcome prediction. The only serum biomarker presently recommended in the European Resuscitation Council prognostication guidelines is neuron-specific enolase (NSE), but NSE has limitations. In this study, we therefore analyzed the outcome predictive accuracy of the serum biomarkers glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) in patients after cardiac arrest. Methods: Serum GFAP and UCH-L1 were collected at 24, 48 and 72 h after cardiac arrest. The primary outcome was neurological function at 6-month follow-up assessed by the cerebral performance category scale (CPC), dichotomized into good (CPC1-2) and poor (CPC3-5). Prognostic accuracies were tested with receiver-operating characteristics by calculating the area under the receiver-operating curve (AUROC) and compared to the AUROC of NSE. Results: 717 patients were included in the study. GFAP and UCH-L1 discriminated between good and poor neurological outcome at all time-points when used alone (AUROC GFAP 0.88–0.89; UCH-L1 0.85–0.87) or in combination (AUROC 0.90–0.91). The combined model was superior to GFAP and UCH-L1 separately and NSE (AUROC 0.75–0.85) at all time-points. At specificities ≥95%, the combined model predicted poor outcome with a higher sensitivity than NSE at 24 h and with similar sensitivities at 48 and 72 h. Conclusion: GFAP and UCH-L1 predicted poor neurological outcome with high accuracy. Their combination may be of special interest for early prognostication after cardiac arrest where it performed significantly better than the currently recommended biomarker NSE.</p>},
  author       = {Ebner, Florian and Moseby-Knappe, Marion and Mattsson-Carlgren, Niklas and Lilja, Gisela and Dragancea, Irina and Undén, Johan and Friberg, Hans and Erlinge, David and Kjaergaard, Jesper and Hassager, Christian and Wise, Matt P. and Kuiper, Michael and Stammet, Pascal and Wanscher, Michael and Horn, Janneke and Ullén, Susann and Cronberg, Tobias and Nielsen, Niklas},
  issn         = {0300-9572},
  language     = {eng},
  pages        = {61--68},
  publisher    = {Elsevier},
  series       = {Resuscitation},
  title        = {Serum GFAP and UCH-L1 for the prediction of neurological outcome in comatose cardiac arrest patients},
  url          = {http://dx.doi.org/10.1016/j.resuscitation.2020.05.016},
  doi          = {10.1016/j.resuscitation.2020.05.016},
  volume       = {154},
  year         = {2020},
}