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

COMACARE Study Groups, Jaana J Humaloja, Marika Lähde, Nicholas J. Ashton, Matti Reinikainen, Johanna Hästbacka, Pekka Jakkula, Hans Friberg, Tobias Cronberg, Ville Pettilä, Kaj Blennow, Henrik Zetterberg, Markus Skrifvars, Talvikki Koskue, Pekka Loisa

Research output: Contribution to journalArticleScientificpeer-review

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).

Original languageEnglish
JournalResuscitation
Volume170
Pages (from-to)141-149
Number of pages9
ISSN0300-9572
DOIs
Publication statusPublished - Jan 2022
MoE publication typeA1 Journal article-refereed

Fields of Science

  • 3112 Neurosciences
  • 3124 Neurology and psychiatry
  • 3126 Surgery, anesthesiology, intensive care, radiology
  • Out-of-hospital cardiac arrest
  • Biomarkers
  • Tau protein
  • Glial fibrillary acidic protein
  • Neurological outcome prognostication
  • FIBRILLARY ACIDIC PROTEIN
  • EUROPEAN-RESUSCITATION-COUNCIL
  • AMERICAN-HEART-ASSOCIATION
  • CARE MEDICINE GUIDELINES
  • BRAIN-INJURY
  • COMATOSE PATIENTS
  • SERUM-LEVELS
  • BIOMARKERS
  • HYPOTHERMIA
  • DIFFUSION

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