Investigation of biomarker variations post-return of spontaneous circulation following an out-of-hospital cardiac arrest

Adela Golea 1 , Adriana Rusu 2 , Christiana Dumulesc 3 , and Cornelia Bala 4
  • 1 Iuliu Hatieganu University of Medicine and Pharmacy, Department of Emergency Medicine, , Cluj- Napoca, Romania
  • 2 Iuliu Hatieganu University of Medicine and Pharmacy, Department of Diabetes, Nutrition and Metabolic Diseases, , Cluj-Napoca, Romania
  • 3 Iuliu Hatieganu University of Medicine and Pharmacy, , Cluj-Napoca, Romania
  • 4 Iuliu Hatieganu University of Medicine and Pharmacy, Department of Diabetes, Nutrition and Metabolic Diseases, , Cluj-Napoca, Romania


Objective: The objective of this research was to describe evolution of several biomarkers post-return of spontaneous circulation (ROSC) following an out-of-hospital cardiac arrest (OHCA). Methods: Thirteen adult patients were divided in 2 groups according to their survival status at 30 days, survivors (alive at 30 days or discharged alive) and non-survivors (not alive at 30 days). Glycemia, lactate, C-reactive protein (CRP), neurofilament heavy chain (NfH) and presepsin were assessed at pre-set time-points, during OHCA and the first 72 hours post-ROSC. Results: In survivors, lactate levels decreased steadily throughout the 72 hours from a maximum observed during OHCA; in non-survivors, it increased during ROSC, then decreased abruptly at 2 hours post-ROSC and remained lower than in survivors for up to 24 hours. Glycemia at all-time points within the first 24 hours and CRP levels at 2 hours post-ROSC were higher in non-survivors, but this observed difference was not statistically significant. The variation of NfH was bi-modal, with peaks at 12 and 48 hours. The interpretation of NfH was limited by the large number of samples outside the limit of detection. Conclusion: Glycemia, lactate and CRP showed different patterns of evolution in survivors and non-survivors and should be further investigated as potential predictors of survival after ROSC

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  • 1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics-- 2015 update: a report from the American Heart Association. Circulation. 2015 Jan;131(4):e29-322. DOI: 10.1161/CIR.0000000000000152

  • 2. Muller D, Agrawal R, Arntz HR. How sudden is sudden cardiac death? Circulation. Sep;114(11):1146-50.

  • 3. Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. Sep;300(12):1423-31.

  • 4. Centers for Disease Control and Prevention. 2013 Cardiac Arrest Registry to Enhance Survival (CARES) National Summary Report. Accessed November 11, 2016.

  • 5. Gräsner JT, Böttiger BW, Bossaert L; European Registry of Cardiac Arrest (EuReCa) ONE Steering Committee; EuReCa ONE Study Management Team. EuReCa ONE - ONE month - ONE Europe - ONE goal. Resuscitation. 2014 Oct;85(10):1307-8. DOI: 10.1016/j. resuscitation.2014.08.001

  • 6. Gräsner JT, Lefering R, Koster RW, Masterson S, Böttiger BW, Herlitz J, et al. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016 Aug;105:188-95. DOI: 10.1016/j.resuscitation.2016.06.004

  • 7. Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg RA, Böttiger BW, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation. 2008 Dec;118(23):2452-83. DOI: 10.1161/CIRCULATIONAHA.108.190652

  • 8. Jeng JC, Jablonski K, Bridgeman A, Jordan MH. Serum lactate, not base deficit, rapidly predicts survival after major burns. Burns 2002 Mar;28(2):161-6. DOI: 10.1016/S0305-4179(01)00098-5

  • 9. Kamolz LP, Andel H, Schramm W, Meissl G, Herndon DN, Frey M. Lactate: early predictor of morbidity and mortality in patients with severe burns. Burns 2005 Dec;31(8):986-90. DOI: 10.1016/j.burns.2005.06.019

  • 10. Callaway DW, Shapiro NI, Donnino MW, Baker C, Rosen CL. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma 2009; Apr;66(4):1040-4. DOI: 10.1097/TA.0b013e3181895e9e

  • 11. Cocchi MN, Miller J, Hunziker S, Carney E, Salciccioli J, Farris S. The association of lactate and vasopressor need for mortality prediction in survivors of cardiac arrest. Minerva Anestesiol. 2011 Nov;77(11):1063-71.

  • 12. Yuan A, Rao MV, Veeranna, Nixon RA. Neurofilaments at a glance. J Cell Sci. 2012 Jul;125(Pt 14):3257-63. DOI: 10.1242/jcs.104729

  • 13. Petzold A. Neurofilament phosphoforma: Surrogate markters for axomal injury, degeneration and loss. J Neurol Sci. 2005 Jun 15;233(1-2):183-98. DOI: 10.1016/j.jns.2005.03.015

  • 14. Kuhle J, Leppert D, Petzold A, Regeniter A, Schindler C, Mehlin M, Anthony DC, Kappos L, Lindberg RL. Neurofilament heavy chain in CSF correlates with relapses and disability in multiple sclerosis. Neurology. 2011 Apr 5;76(14):1206-13. DOI: 10.1212/WNL.0b013e31821432ff

  • 15. Rundgren M, Friberg H, Cronberg T, Romner B, Petzold A. Serial soluble neurofilament heavy chain in plasma as a marker of brain injury after cardiac arrest. Crit Care. 2012 Dec;16(2):R45. DOI: 10.1186/cc11244

  • 16. Samborska-Sablik A, Sablik Z, Gaszynski W. The role of the immuno-inflammatory response in patients after cardiac arrest. Arch Med Sci. 2011 Aug;7(4):619-26. DOI: 10.5114/aoms.2011.24131

  • 17. Wu J, Hu L, Zhang G, Wu F, He T. Accuracy of Presepsin in Sepsis Diagnosis: A Systematic Review and Meta-Analysis. PLoS One. 2015 Jul;10(7):e0133057. DOI: 10.1371/journal.pone.0133057

  • 18. Sandquist M, Wong HR. Biomarkers of sepsis and their potential value in diagnosis, prognosis and treatment. Clin Immunol. 2014 Oct;10(10):1349-56. DOI: 10.1586/1744666x.2014.949675

  • 19. Donnino MW, Miller J, Goyal N, Loomba M, Sankey SS, Dolcourt B, et al. Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients. Resuscitation. 2007 Nov;75(2):229-34. DOI: 10.1016/j.resuscitation.2007.03.021

  • 20. Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc. 2013 Oct;88(10):1127-40. DOI: 10.1016/j.mayocp.2013.06.012

  • 21. Plummer MP, Bellomo R, Cousins CE, Annink CE, Sundararajan K, Reddi BA, et al. Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality. Intensive Care Med. 2014 Jul;40(7): 973-80. DOI: 10.1007/s00134-014-3287-7

  • 22. Nurmi J, Boyd J, Anttalainen N, Westerbacka J, Kuisma M. Early increase in blood glucose in patients resuscitated from out-of-hospital ventricular fibrillation predicts poor outcome. Diabetes Care. 2012 Mar;35:510-2. DOI: 10.2337/dc11-1478

  • 23. Adrie C, Adib-Conquy M, Laurent I, Monchi M, Vinsonneau C, Fitting C, et al. Successful cardiopulmonary resuscitation after cardiac arrest as a sepsis-like syndrome. Circulation. 2002 Jul;106:562-8. DOI: 10.1161/01.CIR.0000023891.80661.AD

  • 24. Peberdy MA, Andersen LW, Abbate A, Thacker LR, Gaieski D, Abella B, et al. Inflammatory markers following resuscitation from out-of-hospital cardiac arrest- A prospective multicenter observational study. Resuscitation. 2016 Jun;103:117-24. DOI: 10.1016/j.resuscitation.2016.01.006

  • 25. Zhang YP, Zhu YB, Duan DD, Fan XM, He Y, Su JW, et al. Serum UCH-L1 as a Novel Biomarker to Predict Neuronal Apoptosis Following Deep Hypothermic Circulatory Arrest. Int J Med Sci. 2015 Jul;12(7):576-82. DOI: 10.7150/ijms.12111


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