Abstract 131: Elevated Serum MPEG-1 Protein is Associated With Reduced Survival and Poor Neurological Recovery in Resuscitated Out-Of-Hospital Sudden Cardiac Arrest

Abstract

Background: For decades, bio-markers involved in inflammation and stress response were implicated in patients who were successfully resuscitated from out of hospital cardiac arrest (sR-OHCA). Here we report that increased serum levels of Macrophage-expressed gene 1 (MPEG1), an evolutionary conserved protein with membrane attack complex domain, is associated with increased mortality and poor neurological outcomes after sR-OHCA. Objectives: To examine the association between circulating MPEG-1 protein measured within the first 6-hours of sR-OHCA, and inpatient survival and neurological outcomes. Methods: We prospectively enrolled 144 sR-OHCA patients from 4 different tertiary care centers. We measured MPEG-1 protein, and other conventional clinical bio-markers including troponin-I and CK-MB in the sera obtained within the first 6-hours of resuscitation. The clinical covariates during hospitalization (till the time death or discharge) were obtained via medical record review. We compared MPEG-1 protein, troponin-I, and CK-MB between survivors vs . non-survivors, and neurological outcomes dichotomized as poor or good according to cerebral performance score (CPS). Results: At the end of the hospital stay, 47% of the patients had poor neurological status based on the CPS score of ≥ 4. Within these patients, 95% had inhospital mortality. The mean serum MPEG-1 levels were significantly higher in patients with poor neurological status, compared to the ones with good neurological recovery (ng/ml, 15.17 ± 48.04 vs 1.15 ± 6.73, p=0.017). There were no differences in other conventionally measured bio-markers, such as peak troponin , CK-MB or left ventricular ejection fraction. Elevated MPEG-1 of more than 8.8 ng/ml had significantly higher odds of predicting poor neurological outcome (OR: 8.37, 95% CI: 1.79-39.14, p=0.006). Conclusions: This study reports a novel macrophage-expressed circulating bio-marker strongly associated with reduced survival and poor neurological outcomes in sR-OHCA. These data can guide clinicians to prognosticate survival and neurological outcomes in sR-OHCA, and also form the basis for future therapeutic approaches.