Aim

To determine the ability of serum glial fibrillary acidic protein (GFAp) and tau protein to predict neurological outcome after out-of-hospital cardiac arrest (OHCA).

Methods

We measured plasma concentrations of GFAp and tau of patients included in the previously published COMACARE trial (NCT02698917) on intensive care unit admission and at 24, 48, and 72 h after OHCA, and compared them to neuron specific enolase (NSE). NSE concentrations were determined already during the original trial. We defined unfavourable outcome as a cerebral performance category (CPC) score of 3–5 six months after OHCA. We determined the prognostic accuracy of GFAp and tau using the receiver operating characteristic curve and area under the curve (AUROC).

Results

Overall, 39/112 (35%) patients had unfavourable outcomes. Over time, both markers were evidently higher in the unfavourable outcome group (p < 0.001). At 48 h, the median (interquartile range) GFAp concentration was 1514 (886–4995) in the unfavourable versus 238 (135–463) pg/ml in the favourable outcome group (p < 0.001). The corresponding tau concentrations were 99.6 (14.5–352) and 3.0 (2.2–4.8) pg/ml (p < 0.001). AUROCs at 48 and 72 h were 0.91 (95% confidence interval 0.85–0.97) and 0.91 (0.85–0.96) for GFAp and 0.93 (0.86–0.99) and 0.95 (0.89–1.00) for tau. Corresponding AUROCs for NSE were 0.86 (0.79–0.94) and 0.90 (0.82–0.97). The difference between the prognostic accuracies of GFAp or tau and NSE were not statistically significant.

Conclusions

At 48 and 72 h, serum both GFAp and tau demonstrated excellent accuracy in predicting outcomes after OHCA but were not superior to NSE.

Clinical trial registration

NCT02698917 (https://www.clinicaltrials.gov/ct2/show/NCT02698917).

中文翻译：

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GFAp 和 tau 蛋白作为院外心脏骤停后神经系统结果的预测因子：COMACARE 试验的事后分析

目的

确定血清胶质纤维酸性蛋白 (GFAp) 和 tau 蛋白预测院外心脏骤停 (OHCA) 后神经系统结果的能力。

方法

我们测量了先前发表的 COMACARE 试验 (NCT02698917) 中纳入的患者在重症监护病房入院时和 OHCA 后 24、48 和 72 小时的血浆 GFAp 和 tau 浓度，并将其与神经元特异性烯醇化酶 (NSE) 进行比较。NSE 浓度在最初的试验中已经确定。我们将不良结果定义为 OHCA 后 3-5 个月的脑性能类别 (CPC) 评分。我们使用受试者工作特征曲线和曲线下面积 (AUROC) 确定了 GFAp 和 tau 的预后准确性。

结果

总体而言，39/112 (35%) 名患者的结果不佳。随着时间的推移，两个标志物在不利结果组中明显更高（p < 0.001）。在 48 小时，中位（四分位距）GFap 浓度在不利组中为 1514（886-4995），而在有利结果组中为 238（135-463）pg/ml（p < 0.001）。相应的 tau 浓度为 99.6 (14.5–352) 和 3.0 (2.2–4.8) pg/ml (p < 0.001)。GFAp 在 48 和 72 小时的 AUROC 分别为 0.91（95% 置信区间 0.85-0.97）和 0.91（0.85-0.96），tau 为 0.93（0.86-0.99）和 0.95（0.89-1.00）。NSE 的相应 AUROC 为 0.86 (0.79–0.94) 和 0.90 (0.82–0.97)。GFAp 或 tau 与 NSE 的预后准确性之间的差异无统计学意义。

结论

在 48 和 72 小时，血清 GFAp 和 tau 在预测 OHCA 后结果方面表现出出色的准确性，但并不优于 NSE。

临床试验注册

NCT02698917 (https://www.clinicaltrials.gov/ct2/show/NCT02698917)。