Abstract
Introduction and Hypothesis: Patients with post-cardiac arrest syndrome (PCAS) rely on precise and timely diagnosis for good clinical outcomes. Our study sought to evaluate novel serum parameters' diagnostic and clinical efficacy in prognosticating neurological outcomes in post-cardiac arrest syndrome patients. Methods: 345 patients with cardiac arrest treated with target temperature management were enrolled in this retrospective, multicenter study. Blood samples were drawn and evaluated at a period of 0, 1, 2, and 3 days. Samples were analyzed for conventional biomarkers; S100 calcium-binding protein (S-100B) and neuron-specific enolase, and for novel biomarkers; ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL), and tau load. Patients were followed up for neurological outcomes over 6 months period Results: 328 patients completed the study in which the mean age was 68.4 years, and 23% were female. Normal values for NFL, UCH-L1, and tau proteins showed the highest sensitivity (91.8-96% of patients with poor neurological outcomes had abnormal values) and negative predictive value (90-94.5% with good neurological outcomes had normal values). Overall, all the novel biomarkers had independent statistically significant values for the diagnosis of clinical outcome (p<0.005). The area under the curves of the novel serum biomarkers was highest at 72 h post-cardiac arrest (0.913 for NFL, 0.88 for tau, 0.961 for GFAP, and 0.947 for UCH-L1). Conclusions: Our study concluded that low levels of novel serum biomarkers are associated with good neurological outcomes. The reliability of these novel biomarkers highlights that they should be included in baseline laboratory investigation for better prognostication of neurological outcomes in patients with PCAS.
Published Version
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