Background: Biomarkers involved in inflammation and stress response were implicated in patients who were successfully resuscitated from out of hospital cardiac arrest (sR-OHCA). Here we report that macrophage-expressed gene, perforin-2, an evolutionarily conserved protein with membrane attack domain, is associated with poor neurological outcomes and mortality after sR-OHCA.Objectives: To examine the association between circulating perforin-2 protein measured within 6-hours of sR-OHCA, mortality and neurological outcomes.
Methods:We prospectively enrolled 144 sR-OHCA patients from 4 different tertiary care centers. We measured perforin-2 and other conventional clinical biomarkers and compared between survivors vs. non-survivors. The neurological outcomes were dichotomized as poor or good according to the cereberal performance score.Results: At the end of the hospital stay, 47% of the patients had poor neurological status, of whom 95% had in-hospital mortality. Serum perforin-2 levels were significantly higher in patients with poor neurological status, compared to the ones with good neurological recovery (ng/ml, 13.7 ± 45.9 vs. 1.2 ± 7.0, p=0.01). There were no differences in other routinely measured biomarkers and left ventricular ejection fraction. On multivariate logistic regression, elevated perforin-2 (OR: 12.78, 95% CI: 1.0-17.8, p=0.02), comatose on presentation (OR: 27.82, 95% CI: 0.2 -19.5, p=0.02) and non-shockable rhythm were the significant predictors of poor neurological outcome.
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