Novel biomarkers of oxidative stress as predictive indicators of neurological outcome after out-of-hospital cardiopulmonary arrest.

Abstract

Among patients of out-of-hospital cardiopulmonary arrest (OHCPA), only 6% resume their pre-OHCPA social life. The prediction of neurological outcome immediately after the return of spontaneous circulation (ROSC) is urgently needed in OHCPA patients. Novel biomarkers, biological antioxidant potential (BAP), and diacron-reactive oxygen metabolites (d-ROM) are potential predictors of neurological outcome after OHCPA. This study was conducted to evaluate the utility of BAP and d-ROM in the prediction of patient outcomes after OHCPA. Blood samples were collected immediately after OHCPA patients were admitted to our hospital between May 2011 and June 2013. BAP and d-ROM concentrations were measured with the simple equipment FRAS4 ™ (Wismerll, Italy). Their association with favorable (cerebral performance category [CPC], 1 and 2) and unfavorable (CPC 3-5) clinical outcomes was compared. BAP and d-ROM values from 23 normal healthy volunteers (HV) were used as controls. Overall, 152 OHCPA patients were included, and 26 patients achieved ROSC. Eleven died during hospitalization were allocated a CPC of 5 and remaining patients were discharged or transported (CPC 1: n=4; CPC 2: n=6; CPC 3: n=3; CPC 4: n=2; CPC 5: n=11). The receiver operating characteristics curve of d-ROM and BAP for predicting survival 28days after OHCPA was 0.596 and 0.834, respectively. Patients without ROSC had significantly higher BAP than HV and patients with ROSC (p<0.001). A significant correlation was evident between BAP and the time to ROSC (r=0.641, p<0.01). Oxidative stress, indicated by BAP on admission, strongly correlated with the neurological outcome after OHCPA.