Serum Neutrophil Gelatinase–Associated Lipocalin Predicts Survival After Resuscitation From Cardiac Arrest

Abstract

Objective In the first days after cardiac arrest, accurate prognostication is challenging. Serum biomarkers are a potentially attractive adjunct for prognostication and risk stratification. Our primary objective in this exploratory study was to identify novel early serum biomarkers that predict survival after cardiac arrest earlier than currently possible. Design Prospective, observational study Setting A single academic medical center Subjects Adult subjects who sustained cardiac arrest with return of spontaneous circulation Intervention None Measurements and Main Results We obtained blood samples from each subject at enrollment, 6, 12, 24, 48 and 72 hours after return of spontaneous circulation. We measured serum levels of novel biomarkers including neutrophil gelatinase-associated lipocalin (NGAL), high-mobility group protein B1 (HMGB), intracellular cell adhesion molecule 1 (ICAM-1) and leptin, as well as previously characterized biomarkers including neuron specific enolase (NSE) and S100B protein. Our primary outcome of interest was survival to hospital discharge. We compared biomarker concentrations at each time point between survivors and non-survivors and used logistic regression to test the unadjusted associations of baseline clinical characteristics and enrollment biomarker levels with survival. Finally, we constructed a series of adjusted models to explore the independent association of each enrollment biomarker level with survival. A total of 86 subjects were enrolled. Enrollment levels of HMGB, NGAL and S100B were higher in non-survivors than survivors. Enrollment leptin, NSE and ICAM-1 levels did not differ between non-survivors and survivors. The discriminatory power of enrollment NGAL level was greatest (c-statistic 0.78 (95%CI 0.66 – 0.90), and remained stable across all time points. In our adjusted models, enrollment NGAL level was independently associated with survival even after controlling for development of acute kidney injury and its addition to clinical models improved overall predictive accuracy. Conclusion Serum NGAL levels are strongly predictive of survival to hospital discharge after cardiac arrest.

Combination of initial neurologic examination, quantitative brain imaging and electroencephalography to predict outcome after cardiac arrest

“…9–18 Recent work has tested predictive value of multiple modalities, but the ideal combination is not known. 28–32 Importantly, not all tests are necessary for all patients and some facilities may not offer all of these modalities. Some authors propose a stepwise approach to avoid premature WLST.…”

Plasma Adipokines in Patients Resuscitated from Cardiac Arrest: Difference of Visfatin between Survivors and Nonsurvivors

“…However, there is little information on serum adipokine concentrations in patients with cardiac arrest. Recently, Elmer et al showed that serum leptin concentration did not differ between nonsurvivors and survivors [30]. This is the only investigation on the role of adipokines in cardiac arrest.…”

Effect of Erythropoietin on Postresuscitation Renal Function in a Swine Model of Ventricular Fibrillation

“…An increase in NGAL within a few hours of cardiac arrest has been suggested to indicate AKI, even in creatinine-negative patients [17, 31]. Considering that NGAL increases early after ROSC, its high levels may be strongly predictive of both AKI and survival-to-hospital discharge [44]. In cardiac surgical patients, however, only L-FABP has been reported as a useful biomarker for early detection of AKI.…”