Can serum markers of brain injury predict good neurological outcome after out‑of‑hospital cardiac arrest?

Abstract

We recently read the article by Marion Moseby-Knappe et al. published in Intensive Care Medicine [1]. The authors suggested that "low levels of brain injury markers in blood are associated with good neurological outcome after cardiac arrest (CA). " Their study provided the predictive value of clinically available markers on the prognosis of patients with postarrest within the Target Temperature Management after out-of-hospital cardiac arrest (TTM) trial. The findings of this study are potentially valuable in clinical practice; however, we would like to discuss our concerns about the methods and results.First, the purpose of the authors' study was to illustrate the relationship between normal brain injury markers in the blood and good outcomes in unconscious patients after CA. The authors emphasized that normal serum levels of neuron-specific enolase (NSE), S100B, and novel markers such as neurofilament light chain (NFL), total tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) could be used to predict good outcome at 6 months. They highlighted that the reference values of these indicators were derived from their own laboratories and previous sources; however, the validity of these references may be doubtful, especially as the main indicators of their research.This study measured neurological function using the Cerebral Performance Category (CPC) scale. Previous studies using the CPC predicted the rate of survivors with good neurological outcome as approximately 90% with most patients scoring CPC 1, whereas only approximately 1.5% of survivors remained in persistent vegetative states

Can serum markers of brain injury predict neurological outcome after out-of-hospital cardiac arrest? Author’s reply

“…We are grateful for the interest in our study shown by Li and Wang who raise concerns about the methods used and interpretation of results [1].…”