Abstract
Whether admission C-reactive protein (aCRP) concentrations are associated with neurological outcome after out-of-hospital cardiac arrest (OHCA) is controversial. Based on established kinetics of CRP, we hypothesized that aCRP may reflect the pre-arrest state of health and investigated associations with neurological outcome. Prospectively collected data from the Vienna Clinical Cardiac Arrest Registry of the Department of Emergency Medicine were analysed. Adults (≥ 18 years) who suffered a non-traumatic OHCA between January 2013 and December 2018 with return of spontaneous circulation, but without extracorporeal cardiopulmonary resuscitation therapy were eligible. The primary endpoint was a composite of unfavourable neurologic function or death (defined as Cerebral Performance Category 3–5) at 30 days. Associations of CRP levels drawn within 30 min of hospital admission were assessed using binary logistic regression. ACRP concentrations were overall low in our population (n = 832), but higher in the unfavourable outcome group [median: 0.44 (quartiles 0.15–1.44) mg/dL vs. 0.26 (0.11–0.62) mg/dL, p < 0.001]. The crude odds ratio for higher aCRP concentrations was 1.19 (95% CI 1.10–1.28, p < 0.001, per mg/dL) to have unfavourable neurological outcome. After multivariate adjustment for traditional prognostication markers the odds ratio of higher aCRP concentrations was 1.13 (95% CI 1.04–1.22, p = 0.002). Sensitivity of aCRP was low, but specificity for unfavourable neurological outcome was 90% for the cut-off at 1.5 mg/dL and 97.5% for 5 mg/dL CRP. In conclusion, high aCRP levels are associated with unfavourable neurological outcome at day 30 after OHCA.
Highlights
Whether admission C-reactive protein concentrations are associated with neurological outcome after out-of-hospital cardiac arrest (OHCA) is controversial
Out-of-hospital cardiac arrest (OHCA) remains a major public health problem that claims over 770,000 lives in Europe and the US a nnually[1,2]
Given the well-known kinetics of C-reactive protein[7], measurements immediately after hospital admission reflect the pre-arrest state of health of patients and are unlikely to be relevantly influenced by the process of cardiopulmonary resuscitation (CPR) itself, which is in contrast to blood samples drawn later during post-resuscitation care
Summary
Whether admission C-reactive protein (aCRP) concentrations are associated with neurological outcome after out-of-hospital cardiac arrest (OHCA) is controversial. Given the well-known kinetics of C-reactive protein[7], measurements immediately after hospital admission reflect the pre-arrest state of health of patients and are unlikely to be relevantly influenced by the process of CPR itself, which is in contrast to blood samples drawn later during post-resuscitation care. Earlier studies showed inconclusive results: Isenschmid et al reported that higher C-reactive protein levels were associated with poor neurologic outcome, but neither specified the timing of blood sampling nor the exact population (OHCA or in-hospital cardiac arrest (IHCA))[8]. Since C-reactive protein is a downstream marker of interleukin-612 with well-known kinetics, these results emphasise the importance of timing of blood analysis Given these limitations and partly contradictory data, we analysed data from a large prospective single centre registry to determine potential associations between C-reactive protein levels measured immediately after hospital admission (within 30 min) and clinical outcomes after OHCA
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