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Serum tau and neurological outcome in cardiac arrest

Mattsson, Niklas LU ; Zetterberg, Henrik LU ; Nielsen, Niklas LU ; Blennow, Kaj LU ; Dankiewicz, Josef LU ; Friberg, Hans LU ; Lilja, Gisela LU ; Insel, Philip S. LU ; Rylander, Christian and Stammet, Pascal, et al. (2017) In Annals of Neurology 82(5). p.665-675
Abstract

Objective: To test serum tau as a predictor of neurological outcome after cardiac arrest. Methods: We measured the neuronal protein tau in serum at 24, 48, and 72 hours after cardiac arrest in 689 patients in the prospective international Target Temperature Management trial. The main outcome was poor neurological outcome, defined as Cerebral Performance Categories 3–5 at 6 months. Results: Increased tau was associated with poor outcome at 6 months after cardiac arrest (median = 38.5, interquartile range [IQR] = 5.7–245ng/l in poor vs median = 1.5, IQR = 0.7–2.4ng/l in good outcome, for tau at 72 hours, p < 0.0001). Tau improved prediction of poor outcome compared to using clinical information (p < 0.0001). Tau cutoffs had low... (More)

Objective: To test serum tau as a predictor of neurological outcome after cardiac arrest. Methods: We measured the neuronal protein tau in serum at 24, 48, and 72 hours after cardiac arrest in 689 patients in the prospective international Target Temperature Management trial. The main outcome was poor neurological outcome, defined as Cerebral Performance Categories 3–5 at 6 months. Results: Increased tau was associated with poor outcome at 6 months after cardiac arrest (median = 38.5, interquartile range [IQR] = 5.7–245ng/l in poor vs median = 1.5, IQR = 0.7–2.4ng/l in good outcome, for tau at 72 hours, p < 0.0001). Tau improved prediction of poor outcome compared to using clinical information (p < 0.0001). Tau cutoffs had low false-positive rates (FPRs) for good outcome while retaining high sensitivity for poor outcome. For example, tau at 72 hours had FPR = 2% (95% CI = 1–4%) with sensitivity = 66% (95% CI = 61–70%). Tau had higher accuracy than serum neuron-specific enolase (NSE; the area under the receiver operating characteristic curve was 0.91 for tau vs 0.86 for NSE at 72 hours, p = 0.00024). During follow-up (up to 956 days), tau was significantly associated with overall survival. The accuracy in predicting outcome by serum tau was equally high for patients randomized to 33 °C and 36 °C targeted temperature after cardiac arrest. Interpretation: Serum tau is a promising novel biomarker for prediction of neurological outcome in patients with cardiac arrest. It may be significantly better than serum NSE, which is recommended in guidelines and currently used in clinical practice in several countries to predict outcome after cardiac arrest. Ann Neurol 2017;82:665–675.

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Annals of Neurology
volume
82
issue
5
pages
11 pages
publisher
John Wiley and Sons Inc.
external identifiers
  • scopus:85034417608
  • wos:000415925900002
ISSN
0364-5134
DOI
10.1002/ana.25067
language
English
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yes
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b33dacfb-08f0-4164-96a1-6918f7432404
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2017-12-18 15:25:46
date last changed
2018-11-21 21:36:46
@article{b33dacfb-08f0-4164-96a1-6918f7432404,
  abstract     = {<p>Objective: To test serum tau as a predictor of neurological outcome after cardiac arrest. Methods: We measured the neuronal protein tau in serum at 24, 48, and 72 hours after cardiac arrest in 689 patients in the prospective international Target Temperature Management trial. The main outcome was poor neurological outcome, defined as Cerebral Performance Categories 3–5 at 6 months. Results: Increased tau was associated with poor outcome at 6 months after cardiac arrest (median = 38.5, interquartile range [IQR] = 5.7–245ng/l in poor vs median = 1.5, IQR = 0.7–2.4ng/l in good outcome, for tau at 72 hours, p &lt; 0.0001). Tau improved prediction of poor outcome compared to using clinical information (p &lt; 0.0001). Tau cutoffs had low false-positive rates (FPRs) for good outcome while retaining high sensitivity for poor outcome. For example, tau at 72 hours had FPR = 2% (95% CI = 1–4%) with sensitivity = 66% (95% CI = 61–70%). Tau had higher accuracy than serum neuron-specific enolase (NSE; the area under the receiver operating characteristic curve was 0.91 for tau vs 0.86 for NSE at 72 hours, p = 0.00024). During follow-up (up to 956 days), tau was significantly associated with overall survival. The accuracy in predicting outcome by serum tau was equally high for patients randomized to 33 °C and 36 °C targeted temperature after cardiac arrest. Interpretation: Serum tau is a promising novel biomarker for prediction of neurological outcome in patients with cardiac arrest. It may be significantly better than serum NSE, which is recommended in guidelines and currently used in clinical practice in several countries to predict outcome after cardiac arrest. Ann Neurol 2017;82:665–675.</p>},
  author       = {Mattsson, Niklas and Zetterberg, Henrik and Nielsen, Niklas and Blennow, Kaj and Dankiewicz, Josef and Friberg, Hans and Lilja, Gisela and Insel, Philip S. and Rylander, Christian and Stammet, Pascal and Aneman, Anders and Hassager, Christian and Kjaergaard, Jesper and Kuiper, Michael and Pellis, Tommaso and Wetterslev, Jørn and Wise, Matthew and Cronberg, Tobias},
  issn         = {0364-5134},
  language     = {eng},
  month        = {11},
  number       = {5},
  pages        = {665--675},
  publisher    = {John Wiley and Sons Inc.},
  series       = {Annals of Neurology},
  title        = {Serum tau and neurological outcome in cardiac arrest},
  url          = {http://dx.doi.org/10.1002/ana.25067},
  volume       = {82},
  year         = {2017},
}