Background: Thirty-day mortality in ST-elevation myocardial infarction (STEMI) patients is primarily driven by cardiogenic shock (CS). High neutrophil counts and high neutrophil/lymphocyte ratios (NLR) have previously been associated with mortality in STEMI patients; however, there is only sparse knowledge regarding their association with CS. Purpose: We sought to assess the associations between neutrophil count and NLR with the development of CS as well as 30-day mortality in STEMI patients. Methods: Patients admitted with STEMI at two tertiary Heart Centres throughout 1 year were included in the study and stratified into quartiles according to the level of leukocyte count upon admission. The primary endpoint was development of CS both before (early CS) and after leaving the catheterization laboratory (late CS). The secondary endpoint was all-cause 30-day mortality. Results: A total of 1,892 STEMI patients were included, whereof 194 (10%) developed CS while 122 (6.4%) died within 30 days. Patients in the highest quartile of neutrophils (OR: 2.54; 95% CI: 1.40–4.60; P = 0.002) and NLR (OR: 3.64; 95% CI: 2.02–6.54; P<0.0001) were at increased risk of developing late CS compared with patients in the lower quartiles, whereas there was no risk difference across quartiles regarding development of early CS. Both biomarkers correlated strongly to an increased 30-day mortality (plogrank<0.0001) and, moreover, a high level of neutrophils was independently associated with 30-day mortality (HR: 1.95; 95% CI: 1.25–3.03; P = 0.003). Conclusion: High levels of neutrophils and a high NLR upon admission for STEMI were independently associated with an increased risk of developing late CS and, additionally, both biomarkers showed association to 30-day mortality.

Background Patients resuscitated from out-of-hospital cardiac arrest (OHCA) have a high morbidity and mortality risk and often develop post-cardiac arrest syndrome (PCAS) involving systemic inflammation. The severity of the inflammatory response is associated with adverse outcome, with anoxic irreversible brain injury as the leading cause of death following resuscitated OHCA. The study aimed to investigate the anti-inflammatory and neuroprotective effect of pre-hospital administration of a high-dose glucocorticoid following OHCA. Methods The study is an investigator-initiated, randomized, multicenter, single-blinded, placebo-controlled, clinical trial. Inclusion will continue until one hundred twenty unconscious OHCA patients surviving a minimum of 72 h are randomized. Intervention is a 1:1 randomization to an infusion of methylprednisolone 250 mg following a minimum of 5 min of sustained return of spontaneous circulation in the pre-hospital setting. Methylprednisolone will be given as a bolus infusion of 1 × 250 mg (1 × 4 mL) over a period of 5 min. Patients allocated to placebo will receive 4 mL of isotonic saline (NaCl 0.9%). Main eligibility criteria are OHCA of presumed cardiac cause, age ≥ 18 years, Glasgow Coma Scale ≤ 8, and sustained ROSC for at least 5 min. Co-primary endpoint: Reduction of interleukin-6 and neuron-specific-enolase. Secondary endpoints: Markers of inflammation, brain, cardiac, kidney and liver damage, hemodynamic and hemostatic function, safety, neurological function at follow-up, and mortality. A research biobank is set up with blood samples taken daily during the first 72 h from hospitalization to evaluate primary and secondary endpoints. Discussion We hypothesize that early anti-inflammatory steroid treatment in the pre-hospital setting can mitigate the progression of PCAS following resuscitated OHCA. Primary endpoints will be assessed through analyses of biomarkers for inflammation and neurological damage taken during the first 72 h of admission. Trial registration EudraCT number: 2020-000855-11; submitted March 30, 2020 ClinicalTrials.gov Identifier: NCT04624776; submitted October 12, 2020, first posted November 10, 2020

Neutrophil gelatinase-associated lipocalin (NGAL) is an inflammatory biomarker related to acute kidney injury (AKI). Including 1892 consecutive patients with ST-elevation myocardial infarction (STEMI), in which NGAL was measured in 1624 (86%) on admission and in a consecutive subgroup at 6–12 h (n = 163) and 12–24 h (n = 222) after admission, this study aimed to evaluate the prognostic value of NGAL in predicting AKI and mortality. Patients were stratified based on whether their admission NGAL plasma concentration was greater than or equal to/less than the median. The primary endpoint was a composite of the first occurrence of AKI or all-cause death within 30 days. AKI was classified by the maximal plasma creatinine increase from baseline during index admission as KDIGO1 (<200% increase) or KDIGO23 (≥200% increase) according to the Kidney Disease Improving Global Outcomes (KDIGO) system. Admission NGAL > the median was independently associated with a higher risk of severe AKI (KDIGO2-3) and 30-day all-cause mortality when adjusted for age, admission systolic blood pressure and high-sensitivity C-reactive protein, left-ventricular ejection fraction, known kidney dysfunction, and cardiogenic shock with an odds ratio (95% confidence interval) of 2.26 (1.18–4.51), p = 0.014. Finally, we observed increasing predictive values in a subgroup during the first day of hospitalization suggesting that assessment of NGAL should be delayed for optimal prognostic purposes.

Background: In intensive care unit (ICU) patients with coma and other disorders of consciousness (DoC), outcome prediction is key to decision-making regarding prognostication, neurorehabilitation, and management of family expectations. Current prediction algorithms are largely based on chronic DoC, while multimodal data from acute DoC are scarce. Therefore, CONNECT-ME (Consciousness in neurocritical care cohort study using EEG and fMRI,NCT02644265) investigates ICU-patients with acute DoC due to traumatic and non-traumatic brain injuries, utilizing EEG (resting-state and passive paradigms), fMRI (resting-state) and systematic clinical examinations. Methods: We previously presented results for a subset of patients (n=87) concerning prediction of consciousness levels at ICU discharge. Now, we report 3- and 12-month outcomes in an extended cohort (n=123). Favourable outcome was defined as modified Rankin Scale ≤3, Cerebral Performance Category ≤2, and Glasgow Outcome Scale-Extended ≥4. EEG-features included visual-grading, automated spectral categorization, and Support Vector Machine (SVM) consciousness classifier. fMRI-features included functional connectivity measures from six resting-state networks. Random-Forest and SVM machine learning were applied to EEG- and fMRI-features to predict outcomes. Here, Random-Forest results are presented as area under the curve (AUC) of receiver operating curves or accuracy. Cox proportional regression with in-hospital death as competing risk was used to assess independent clinical predictors of time to favourable outcome. Results: Between April-2016 and July-2021, we enrolled 123 patients (mean age 51 years, 42% women). Of 82 (66%) ICU-survivors, 3- and 12-month outcomes were available for 79 (96%) and 77 (94%), respectively. EEG-features predicted both 3-month (AUC 0.79[0.77-0.82] and 12-month (0.74[0.71-0.77]) outcomes. fMRI-features appeared to predict 3-month outcome (accuracy 0.69-0.78) both alone and when combined with some EEG-features (accuracies 0.73-0.84), but not 12-month outcome (larger sample sizes needed). Independent clinical predictors of time to favourable outcome were younger age (Hazards-Ratio 1.04[95% CI 1.02-1.06]), TBI (1.94[1.04-3.61]), command-following abilities at admission (2.70[1.40-5.23]), initial brain-imaging without severe pathology (2.42[1.12-5.22]), improving consciousness in the ICU (5.76[2.41-15.51]), and favourable visual-graded EEG (2.47[1.46-4.19]). Conclusion: For the first time, our results indicate that EEG- and fMRI-features and readily available clinical data reliably predict short-term outcome of patients with acute DoC, and EEG also predicts 12-month outcome after ICU discharge.