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- Title
Serial soluble neurofilament heavy chain in plasma as a marker of brain injury after cardiac arrest.
- Authors
Rundgren, Malin; Friberg, Hans; Cronberg, Tobias; Romner, Bertil; Petzold, Axel
- Abstract
<bold>Introduction: </bold>Induced hypothermia has been shown to improve outcome after cardiac arrest, but early prognostication is hampered by the need for sedation. Here we tested whether a biomarker for neurodegeneration, the neurofilament heavy chain (NfH), may improve diagnostic accuracy in the first days after cardiac arrest.<bold>Methods: </bold>This prospective study included 90 consecutive patients treated with hypothermia after cardiac arrest. Plasma levels of phosphorylated NfH (SMI35) were quantified using standard ELISA over a period of 72 h after cardiac arrest. The primary outcome was the dichotomized Cerebral Performance Categories scale (CPC). A best CPC 1-2 during 6 months follow-up was considered a good outcome, a best CPC of 3-4 a poor outcome. Receiver operator characteristics and area under the curve were calculated.<bold>Results: </bold>The median age of the patients was 65 years, and 63 (70%) were male. A cardiac aetiology was identified in 62 cases (69%). 77 patients (86%) had out-of-hospital cardiac arrest. The outcome was good in 48 and poor in 42 patients. Plasma NfH levels were significantly higher 2 and 36 hours after cardiac arrest in patients with poor outcome (median 0.28 ng/mL and 0.5 ng/mL, respectively) compared to those with good outcome (0 ng/mL, p = 0.016, p < 0.005, respectively). The respective AUC were 0.72 and 0.71.<bold>Conclusions: </bold>Plasma NfH levels correlate to neurological prognosis following cardiac arrest. In this study, 15 patients had neurological co-morbidities and there was a considerable overlap of data. As such, neurofilament should not be used for routine neuroprognostication until more data are available.
- Subjects
CARDIAC arrest; HEART diseases; HEART failure; INDUCED hypothermia; BODY temperature; HYPOTHERMIA; CYTOPLASMIC filaments
- Publication
Critical Care, 2012, Vol 16, Issue 1, pR45
- ISSN
1364-8535
- Publication type
journal article
- DOI
10.1186/cc11244