Huang Sih-Shiang, Huang Chien-Hua, Hsu Nai-Tan, Ong Hooi-Nee, Lin Jr-Jiun, Wu Yi-Wen, Chen Wei-Ting, Chen Wen-Jone, Chang Wei-Tien, Tsai Min-Shan
Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan.
Cardiology Division, Department of Internal Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan.
Neurocrit Care. 2025 Feb;42(1):142-151. doi: 10.1007/s12028-024-02055-6. Epub 2024 Jul 9.
Phosphorylated Tau (p-Tau), an early biomarker of neuronal damage, has emerged as a promising candidate for predicting neurological outcomes in cardiac arrest (CA) survivors. Despite its potential, the correlation of p-Tau with other clinical indicators remains underexplored. This study assesses the predictive capability of p-Tau and its effectiveness when used in conjunction with other predictors.
In this single-center retrospective study, 230 CA survivors had plasma and brain computed tomography scans collected within 24 h after the return of spontaneous circulation (ROSC) from January 2016 to June 2023. The patients with prearrest Cerebral Performance Category scores ≥ 3 were excluded (n = 33). The neurological outcomes at discharge with Cerebral Performance Category scores 1-2 indicated favorable outcomes. Plasma p-Tau levels were measured using an enzyme-linked immunosorbent assay, diastolic blood pressure (DBP) was recorded after ROSC, and the gray-to-white matter ratio (GWR) was calculated from brain computed tomography scans within 24 h after ROSC.
Of 197 patients enrolled in the study, 54 (27.4%) had favorable outcomes. Regression analysis showed that higher p-Tau levels correlated with unfavorable neurological outcomes. The levels of p-Tau were significantly correlated with DBP and GWR. For p-Tau to differentiate between neurological outcomes, an optimal cutoff of 456 pg/mL yielded an area under the receiver operating characteristic curve of 0.71. Combining p-Tau, GWR, and DBP improved predictive accuracy (area under the receiver operating characteristic curve = 0.80 vs. 0.71, p = 0.008).
Plasma p-Tau levels measured within 24 h following ROSC, particularly when combined with GWR and DBP, may serve as a promising biomarker of neurological outcomes in CA survivors, with higher levels predicting unfavorable outcomes.
磷酸化tau蛋白（p-Tau）是神经元损伤的早期生物标志物，已成为预测心脏骤停（CA）幸存者神经功能预后的一个有前景的候选指标。尽管其具有潜力，但p-Tau与其他临床指标的相关性仍未得到充分研究。本研究评估了p-Tau的预测能力及其与其他预测指标联合使用时的有效性。
在这项单中心回顾性研究中，230例CA幸存者在2016年1月至2023年6月自主循环恢复（ROSC）后24小时内收集了血浆和脑部计算机断层扫描。排除心脏骤停前脑功能分类评分≥3的患者（n = 33）。出院时脑功能分类评分为1-2表示预后良好。采用酶联免疫吸附测定法测量血浆p-Tau水平，记录ROSC后的舒张压（DBP），并在ROSC后24小时内从脑部计算机断层扫描中计算灰质与白质比率（GWR）。
在纳入研究的197例患者中，54例（27.4%）预后良好。回归分析表明，较高的p-Tau水平与不良神经功能预后相关。p-Tau水平与DBP和GWR显著相关。为了使p-Tau能够区分神经功能预后，最佳截断值为456 pg/mL时，受试者工作特征曲线下面积为0.71。联合使用p-Tau、GWR和DBP可提高预测准确性（受试者工作特征曲线下面积=0.80对0.71，p = 0.008）。
ROSC后24小时内测量的血浆p-Tau水平，特别是与GWR和DBP联合使用时，可能是CA幸存者神经功能预后的一个有前景的生物标志物，水平越高预示预后越差。
