Elsevier

Resuscitation

Volume 170, January 2022, Pages 141-149
Resuscitation

Clinical paper
GFAp and tau protein as predictors of neurological outcome after out-of-hospital cardiac arrest: A post hoc analysis of the COMACARE trial

https://doi.org/10.1016/j.resuscitation.2021.11.033Get rights and content
Under a Creative Commons license
open access

Abstract

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).

Keywords

Out-of-hospital cardiac arrest
Biomarkers
Tau protein
Glial fibrillary acidic protein
Neurological outcome prognostication

Cited by (0)

1

Central Finland Central Hospital: Raili Laru-Sompa, Anni Pulkkinen, Mikko Reilama, Sinikka Tolmunen; Helsinki University Hospital: Minna Bäcklund, Jonna Heinonen, Johanna Hästbacka, Pekka Jakkula, Nina Lundbom, Marcus Norrgård, Marjatta Okkonen, Ville Pettilä, Markus B Skrifvars, Tarja Suhonen, Marjaana Tiainen, Tuukka Tikka, Marjut Timonen, Jussi Toppila, Miia Valkonen, Erika Wilkman; Jorvi Hospital: Teemu Hult, Tuomas Oksanen; Kuopio University Hospital: Stepani Bendel, Elina Halonen, Sari Rahikainen, Saija Rissanen, Eija Vaskelainen; North Karelia Central Hospital: Tanja Eiserbeck, Sirkku Heino, Helena Jyrkönen, Matti Reinikainen, Johanna Räsänen, Tero Surakka; Päijät-Häme Central Hospital: Talvikki Koskue, Petteri Kujala, Pekka Loisa, Marika Lähde; Tampere University Hospital: Jari Kalliomäki, Sari Karlsson, Atte Kukkurainen, Simo Varila.