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Humaloja J, Lähde M, Ashton NJ, et al. GFAp and tau protein as predictors of neurological outcome after out-of-hospital cardiac arrest: A post hoc analysis of the COMACARE trial. Resuscitation. 2021;170:141-149doi: 10.1016/j.resuscitation.2021.11.033.
Humaloja, J., Lähde, M., Ashton, N. J., Matti, R., Hästbacka, J., Jakkula, P., Friberg, H., Cronberg, T., Pettilä, V., Blennow, K., Zetterberg, H., Skrifvars, M. B. (2021). GFAp and tau protein as predictors of neurological outcome after out-of-hospital cardiac arrest: A post hoc analysis of the COMACARE trial. Resuscitation, 170141-149. https://doi.org/10.1016/j.resuscitation.2021.11.033
Humaloja, Jaana, et al. "GFAp and tau protein as predictors of neurological outcome after out-of-hospital cardiac arrest: A post hoc analysis of the COMACARE trial." Resuscitation vol. 170 (2021): 141-149. doi: https://doi.org/10.1016/j.resuscitation.2021.11.033
Humaloja J, Lähde M, Ashton NJ, Matti R, Hästbacka J, Jakkula P, Friberg H, Cronberg T, Pettilä V, Blennow K, Zetterberg H, Skrifvars MB. GFAp and tau protein as predictors of neurological outcome after out-of-hospital cardiac arrest: A post hoc analysis of the COMACARE trial. Resuscitation. 2021 Dec 01;170:141-149. doi: 10.1016/j.resuscitation.2021.11.033. Epub 2021 Dec 01. PMID: 34863908.
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Resuscitation. 2021 Dec 01;170:141-149. doi: 10.1016/j.resuscitation.2021.11.033. Epub 2021 Dec 01.

GFAp and tau protein as predictors of neurological outcome after out-of-hospital cardiac arrest: A post hoc analysis of the COMACARE trial.

Resuscitation

Jaana Humaloja, Marika Lähde, Nicholas J Ashton, Reinikainen Matti, Johanna Hästbacka, Pekka Jakkula, Hans Friberg, Tobias Cronberg, Ville Pettilä, Kaj Blennow, Henrik Zetterberg, Markus B Skrifvars,

Affiliations

  1. Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: [email protected].
  2. Department of Anesthesiology and Intensive Care, Päijät-Häme Central Hospital, Lahti, Finland.
  3. Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
  4. Department of Anesthesiology and Intensive Care, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
  5. Department of Anesthesiology, Intensive Care, and Pain Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
  6. Department of Clinical Sciences, Lund, Anaesthesia and Intensive Care, Lund University, Skåne University Hospital, Malmö, Sweden.
  7. Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden.
  8. Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
  9. Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, 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 Center for Neurodegenerative Diseases, Hong Kong, China.
  10. Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

PMID: 34863908 DOI: 10.1016/j.resuscitation.2021.11.033

Abstract

AIM: To determine the ability of serum glial fibrillary acidic protein (GFAp) and tau protein to predict neurological outcome after out-of-hospital cardiac arrest (OHCA).

METHODS: We measured plasma concentrations of GFAp and tau of patients included in the previously published COMACARE trial (NCT02698917) on intensive care unit admission and at 24, 48, and 72 h after OHCA, and compared them to neuron specific enolase (NSE). NSE concentrations were determined already during the original trial. We defined unfavourable outcome as a cerebral performance category (CPC) score of 3-5 six months after OHCA. We determined the prognostic accuracy of GFAp and tau using the receiver operating characteristic curve and area under the curve (AUROC).

RESULTS: Overall, 39/112 (35%) patients had unfavourable outcomes. Over time, both markers were evidently higher in the unfavourable outcome group (p < 0.001). At 48 h, the median (interquartile range) GFAp concentration was 1514 (886-4995) in the unfavourable versus 238 (135-463) pg/ml in the favourable outcome group (p < 0.001). The corresponding tau concentrations were 99.6 (14.5-352) and 3.0 (2.2-4.8) pg/ml (p < 0.001). AUROCs at 48 and 72 h were 0.91 (95% confidence interval 0.85-0.97) and 0.91 (0.85-0.96) for GFAp and 0.93 (0.86-0.99) and 0.95 (0.89-1.00) for tau. Corresponding AUROCs for NSE were 0.86 (0.79-0.94) and 0.90 (0.82-0.97). The difference between the prognostic accuracies of GFAp or tau and NSE were not statistically significant.

CONCLUSIONS: At 48 and 72 h, serum both GFAp and tau demonstrated excellent accuracy in predicting outcomes after OHCA but were not superior to NSE.

CLINICAL TRIAL REGISTRATION: NCT02698917 (https://www.clinicaltrials.gov/ct2/show/NCT02698917).

Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

Keywords: Biomarkers; Glial fibrillary acidic protein; Neurological outcome prognostication; Out-of-hospital cardiac arrest; Tau protein

Conflict of interest statement

Declaration of Competing Interest J. Humaloja, M.L., N.J.A, M.R., J. Hästbacka, P.J., H.F., T.C. and V.P. have nothing to disclose. M.B.S. has received a lecture fee and a travel grant from BARD Medic

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