Abstract
Purpose Postresuscitation neuroprognostication is guided by neurophysiological tests, biomarker measurement, and clinical examination. Recent investigations suggest that circulating microRNAs (miRNA) may help in outcome prediction after cardiac arrest. We assessed the ability of miR-574-5p to predict neurological outcome after cardiac arrest, in a sex-specific manner. Methods In this substudy of the Target Temperature Management (TTM) Trial, we enrolled 590 cardiac arrest patients for which blood samples were available. Expression levels of miR-574-5p were measured by quantitative PCR in plasma samples collected 48 h after cardiac arrest. The endpoint of the study was poor neurological outcome at 6 months (cerebral performance category scores 3 to 5). Results Eighty-one percent of patients were men, and 49% had a poor neurological outcome. Circulating levels of miR-574-5p at 48 h were higher in patients with a poor neurological outcome at 6 months (p < 0.001), both in women and in men. Circulating levels of miR-574-5p were univariate predictors of neurological outcome (odds ratio (OR) [95% confidence interval (CI)]: 1.5 [1.26-1.78]). After adjustment with clinical variables and NSE, circulating levels of miR-574-5p predicted neurological outcome in women (OR [95% CI]: 1.9 [1.09-3.45]), but not in men (OR [95% CI]: 1.0 [0.74-1.28]). Conclusion miR-574-5p is associated with neurological outcome after cardiac arrest in women.
Highlights
Out-of-hospital cardiac arrest (OHCA) is a devastating condition, with overall survival rates lower than 10% [1]
Survival post-OHCA is associated with age, bystander cardiopulmonary resuscitation (CPR), type of first monitored rhythm, and time from cardiac arrest (CA) to the return of spontaneous circulation (ROSC) [2, 3]
It is well documented that the brain is highly sensitive to ischemia, and half of OHCA survivors suffer neurological damage which impacts their quality of life and survival [5]
Summary
Out-of-hospital cardiac arrest (OHCA) is a devastating condition, with overall survival rates lower than 10% [1]. The decision to withdraw life-supporting therapies is currently based on a multimodal approach including clinical examination, electrophysiological tests (absence of somatosensory evoked potential), electroencephalography, brain imaging, and assessment of protein biomarkers such as neuron-specific enolase (NSE) and S100b [7]. Cardiac biomarkers such as N-terminal probrain natriuretic peptide (NT-proBNP) and high-sensitive cardiac troponin T (hs-TnT) are associated with neurological outcome and death after OHCA but are not included in the guidelines [7,8,9]. Despite this multimodal approach, predicting outcome after OHCA, especially at an early stage and in patients with moderate brain damage, is challenging and would benefit from novel biomarkers
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