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

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).

• Authors: Jaana Humaloja, Marika Lähde, Nicholas J Ashton, Matti Reinikainen, Johanna Hästbacka, Pekka Jakkula, Hans Friberg, Tobias Cronberg, Ville Pettilä, Kaj Blennow, Henrik Zetterberg, Markus B Skrifvars, COMACARE Study Groups
• Journal: Resuscitation (Resuscitation) Vol. 170 Pg. 141-149 (01 2022) ISSN: 1873-1570 [Electronic] Ireland
• PMID: 34863908 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

Chemical References

• Biomarkers
• Glial Fibrillary Acidic Protein
• tau Proteins
• Phosphopyruvate Hydratase

Topics

• Biomarkers
• Glial Fibrillary Acidic Protein
• Humans
• Out-of-Hospital Cardiac Arrest (therapy)
• Phosphopyruvate Hydratase
• Prognosis
• Prospective Studies
• ROC Curve
• tau Proteins