Abstract
BackgroundPatients surviving out-of hospital cardicac arrest, with good neurological outcome according to Cerebral Performance Category, frequently have neuropsychological impairment. We studied whether biomarker data (S-100b and neuron-specific enolase) obtained during the ICU stay predicted cognitive impairment 6 months after resuscitation. MethodsPatients (N = 79) with a CPC-score ≤2 were recruited from two trial sites taking part in the TTH48 trial comparing targeted temperature management (TTM) for 48 h vs. 24 h at 33 ± 1 °C. We assessed patients 6 months after the OHCA. We measured biomarkers S-100b and NSE at arrival and at 24, 48 and 72 h after reaching the target temperature of 33 ± 1 °C.Four cognitive domain z-scores were calculated, and global cognitive impairment was defined as z < −1.67 on at least 3 out of 13 cognitive tests. Non-parametric correlations were used to assess the relationship between cognitive domain and biomarkers. ROC curves were used to assess prediction of cognitive impairment from the biomarkers. Logistic regression was used to investigate whether TTM duration moderated biomarker prediction of cognitive impairment. ResultsCognitive impairment was present in 22% of the patients with memory impairment being the most common. The biomarkers correlated significantly with several cognitive domain scores and NSE at 48 h predicted cognitive impairment with 100% sensitivity and 56% specificity. The predictive properties of NSE at 48 h was unaffected by duration of TTM. ConclusionsEarly biomarker prognostication of cognitive impairment is feasible even in OHCA survivors with good neurological outcome as defined by CPC. NSE at 48 h predicted cognitive impairment.
Highlights
In Europe, most survivors of out-of-hospital cardiac arrest (OHCA) have a good neurological outcome, often expressed as Cerebral Performance Category (CPC) of 1 or 2.1 about 50% of these OHCA survivors suffer from cognitive sequela.[2]
In order to assess whether duration of temperature management (TTM) affected the predictive properties of S-100b and NSE, sequential logistic regression analyses were performed with the binary variable indicating cognitive impairment as dependent variable
The prevalence of cognitive impairment was higher in the TTM24 group
Summary
In Europe, most survivors of out-of-hospital cardiac arrest (OHCA) have a good neurological outcome, often expressed as Cerebral Performance Category (CPC) of 1 or 2.1 about 50% of these OHCA survivors suffer from cognitive sequela.[2]. Most studies on neurological prognosis in the early phase after OHCA have employed crude measures of functioning such as the CPC4 which is problematic regarding sensitivity, as considerable cognitive impairment may be present even in patients with good CPC scores of < = 2.5 Even though formal neuropsychological tests should ideally be employed in order to measure cognitive outcome after OHCA, this is often not feasible. There is a need for early predictors of neuropsychological outcome that can be employed regardless of other clinical variables and that are relatively independent from TTM. The biomarkers correlated significantly with several cognitive domain scores and NSE at 48 h predicted cognitive impairment with 100% sensitivity and 56% specificity. Conclusions: Early biomarker prognostication of cognitive impairment is feasible even in OHCA survivors with good neurological outcome as defined by CPC.
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