Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Anesthesiology and Intensive Care, Päijät-Häme Central Hospital, Lahti, Finland.
Resuscitation. 2022 Jan;170:141-149. doi: 10.1016/j.resuscitation.2021.11.033. Epub 2021 Dec 1.
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).
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).
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.
At 48 and 72 h, serum both GFAp and tau demonstrated excellent accuracy in predicting outcomes after OHCA but were not superior to NSE.
NCT02698917 (https://www.clinicaltrials.gov/ct2/show/NCT02698917).
确定血清神经胶质纤维酸性蛋白（GFAp）和 tau 蛋白在院外心脏骤停（OHCA）后预测神经功能预后的能力。
我们测量了纳入先前发表的 COMACARE 试验（NCT02698917）的患者在重症监护病房入院时以及 OHCA 后 24、48 和 72 小时的血浆 GFAp 和 tau 浓度，并将其与神经元特异性烯醇化酶（NSE）进行了比较。NSE 浓度在原始试验中已经确定。我们将不良结局定义为 OHCA 后 6 个月的脑功能预后评分（CPC）为 3-5 分。我们使用受试者工作特征曲线和曲线下面积（AUROC）来确定 GFAp 和 tau 的预后准确性。
总体而言，112 例患者中有 39 例（35%）结局不良。随着时间的推移，不良结局组中两种标志物的水平均明显升高（p<0.001）。在 48 小时时，不良结局组的中位（四分位距）GFAp 浓度为 1514（886-4995）pg/ml，而良好结局组为 238（135-463）pg/ml（p<0.001）。相应的 tau 浓度分别为 99.6（14.5-352）和 3.0（2.2-4.8）pg/ml（p<0.001）。48 和 72 小时时，GFAp 和 tau 的 AUROC 分别为 0.91（95%置信区间 0.85-0.97）和 0.91（0.85-0.96），0.93（0.86-0.99）和 0.95（0.89-1.00）。NSE 的相应 AUROC 为 0.86（0.79-0.94）和 0.90（0.82-0.97）。GFAp 或 tau 与 NSE 之间的预后准确性差异无统计学意义。
在 48 和 72 小时时，血清 GFAp 和 tau 对 OHCA 后预后的预测准确性均较好，但并不优于 NSE。
NCT02698917（https://www.clinicaltrials.gov/ct2/show/NCT02698917）。
