[en] [en] BACKGROUND/AIM: Signs of hypoxic ischaemic encephalopathy (HIE) on head computed tomography (CT) predicts poor neurological outcome after cardiac arrest. We explore whether levels of brain injury markers in blood could predict the likelihood of HIE on CT.
METHODS: Retrospective analysis of CT performed at 24-168 h post cardiac arrest on clinical indication within the Target Temperature Management after out-of-hospital cardiac arrest-trial. Biomarkers prospectively collected at 24- and 48 h post-arrest were analysed for neuron specific enolase (NSE), neurofilament light (NFL), total-tau and glial fibrillary acidic protein (GFAP). HIE was assessed through visual evaluation and quantitative grey-white-matter ratio (GWR) was retrospectively calculated on Swedish subjects with original images available.
RESULTS: In total, 95 patients were included. The performance to predict HIE on CT (performed at IQR 73-116 h) at 48 h was similar for all biomarkers, assessed as area under the receiving operating characteristic curve (AUC) NSE 0.82 (0.71-0.94), NFL 0.79 (0.67-0.91), total-tau 0.84 (0.74-0.95), GFAP 0.79 (0.67-0.90). The predictive performance of biomarker levels at 24 h was AUC 0.72-0.81. At 48 h biomarker levels below Youden Index accurately excluded HIE in 77.3-91.7% (negative predictive value) and levels above Youden Index correctly predicted HIE in 73.3-83.7% (positive predictive value). NSE cut-off at 48 h was 48 ng/ml. Elevated biomarker levels irrespective of timepoint significantly correlated with lower GWR.
CONCLUSION: Biomarker levels can assess the likelihood of a patient presenting with HIE on CT and could be used to select suitable patients for CT-examination during neurological prognostication in unconscious cardiac arrest patients.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Lagebrant, Alice; Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden. Electronic address: alice.lagebrant@med.lu.se
Lang, Margareta; Department of Radiology, Lund University, Helsingborg Hospital, Sweden
Nielsen, Niklas; Department of Clinical Sciences Lund, Anaesthesiology and intensive care, Lund University, Helsingborg Hospital, Sweden
Blennow, Kaj; Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden, Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
Dankiewicz, Josef; Department of Clinical Sciences Lund, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
Friberg, Hans; Department of Clinical Sciences Lund, Anaesthesiology and intensive care, Lund University, Skåne University Hospital, Malmö, Sweden
Hassager, Christian; Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark, Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Horn, Janneke; Dept of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands, Amsterdam Neurosciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
Kjaergaard, Jesper; Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark, Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Kuiper, Mikael A; Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands
Mattsson-Carlgren, Niklas; Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden, Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden, Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
Pellis, Tommaso; Department of Anaesthesiology and Intensive Care, Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
Rylander, Christian; Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
Sigmund, Roger; Department of Radiology, Skåne University Hospital, Lund, Sweden
STAMMET, Pascal ; University of Luxembourg > Faculty of Science, Technology and Medicine (FSTM) > Department of Life Sciences and Medicine (DLSM) > Medical Education
Undén, Johan; Department of Clinical Sciences Lund, Lund University, Sweden, Department of Operation and Intensive Care, Hallands Hospital Halmstad, Lund University, Halland, Sweden
Zetterberg, Henrik; Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden, Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK, UK Dementia Research Institute at UCL, London, UK, Hong Kong Centre for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
Wise, Matt P; Adult Critical Care, University Hospital of Wales, Cardiff, UK
Cronberg, Tobias; Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
Moseby-Knappe, Marion; Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
Funding for the study was provided by the Swedish Research Council, Swedish Heart Lung Foundation, Arbetsmarknadens Försäkringsaktiebolag Insurance Foundation, the Skåne University Hospital Foundations, the Gyllenstierna-Krapperup Foundation, and governmental funding of clinical research within the Swedish National Health System, the County Council of Skåne; the Swedish Society of Medicine; the Koch Foundation; TrygFonden (Denmark); European Clinical Research Infrastructures Network; Thelma Zoega Foundation; Stig and Ragna Gorthon Foundation; Thure Carlsson Foundation; Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research; Lions Research fund Skåne; South Swedish Hospital Region Research Funds; the Swedish Brain Foundation; the Lundbeck Foundation; and the Torsten Söderberg foundation at the Royal Swedish Academy of Sciences. KB is supported by the Swedish Research Council (#2017-00915), the Alzheimer Drug Discovery Foundation (ADDF), USA (#RDAPB-201809-2016615), the Swedish Alzheimer Foundation (#AF-930351, #AF-939721 and #AF-968270), Hjärnfonden, Sweden (#FO2017-0243 and #ALZ2022-0006), the Swedish state under the agreement between the Swedish government and the County Councils, the ALF-agreement (#ALFGBG-715986 and #ALFGBG-965240), the European Union Joint Program for Neurodegenerative Disorders (JPND2019-466-236), the National Institute of Health (NIH), USA, (grant #1R01AG068398-01), and the Alzheimer’s Association 2021 Zenith Award (ZEN-21-848495). HZ is a Wallenberg Scholar supported by grants from the Swedish Research Council (#2018-02532), the European Research Council (#681712 and #101053962), Swedish State Support for Clinical Research (#ALFGBG-71320), the Alzheimer Drug Discovery Foundation (ADDF), USA (#201809-2016862), the AD Strategic Fund and the Alzheimer's Association (#ADSF-21-831376-C, #ADSF-21-831381-C and #ADSF-21-831377-C), the Olav Thon Foundation, the Erling-Persson Family Foundation, Stiftelsen för Gamla Tjänarinnor, Hjärnfonden, Sweden (#FO2019-0228), the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 860197 (MIRIADE), the European Union Joint Programme – Neurodegenerative Disease Research (JPND2021-00694), and the UK Dementia Research Institute at UCL (UKDRI-1003).
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