Elevated Serum Glial Fibrillary Acidic Protein (GFAP) is Associated with Poor Functional Outcome After Cardiopulmonary R
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ORIGINAL ARTICLE
Elevated Serum Glial Fibrillary Acidic Protein (GFAP) is Associated with Poor Functional Outcome After Cardiopulmonary Resuscitation Kirsten Helwig1 • Florian Seeger2 • Hans Ho¨lschermann3 • Volker Lischke4 Tibo Gerriets5,6 • Marion Niessner7 • Christian Foerch1
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Ó Springer Science+Business Media New York 2016
Abstract Background The neurological prognosis of patients after cardiopulmonary resuscitation (CPR) is difficult to assess. GFAP is an astrocytic intermediate filament protein released into bloodstream in case of cell death. We performed a prospective study aiming to compare the predictive potential of GFAP after resuscitation to the more widely used biomarker neuron-specific enolase (NSE). Methods One hundred patients were included at 48 h (tolerance interval ±12 h) after cardiac arrest. A serum sample was collected immediately after study inclusion. We determined serum levels of GFAP and NSE by means of immunoassays. Primary outcome was the modified Glasgow outcome scale at 4 weeks. Values below four were considered as a poor functional outcome. Results Median GFAP levels in poor outcome (n = 61) and good outcome (n = 39) patients were 0.03 lg/L (interquartile range 0.01–0.07 lg/L) and 0.02 lg/L (0.01–0.03 lg/L;
p = 0.014), respectively. GFAP revealed a sensitivity of 60.7% and a specificity of 66.7% to predict a poor functional outcome. All patients having a GFAP level >0.08 lg/L had a poor functional outcome. For NSE, sensitivity was 44.3% and specificity was 100.0% for predicting a poor outcome. Multivariate regression analysis revealed GFAP, NSE, and the Karnofsky index to be independent predictors of outcome. Conclusions The release patterns of GFAP and NSE after CPR show differences. GFAP levels above 0.08 lg/L were associated with a poor outcome in all cases, and patients with strongly elevated values (>3 lg/L) consistently had severe brain damage on brain imaging. Both biomarkers independently contribute to outcome prediction after CPR. Keywords Cardiac arrest GFAP NSE Outcome Biomarker
Introduction & Christian Foerch [email protected] 1
Department of Neurology, Goethe University, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany
2
Department of Cardiology, Goethe University, Frankfurt am Main, Germany
3
Department of Cardiology, Hochtaunus-Kliniken, Bad Homburg, Germany
4
Department of Anesthesiology, Hochtaunus-Kliniken, Bad Homburg, Germany
5
Department of Neurology, Justus Liebig University, Giessen, Germany
6
Department of Neurology, Gesundheitszentrum Wetterau, Friedberg, Germany
7
Roche Diagnostics, Penzberg, Germany
The prediction of functional outcome in patients after cardiopulmonary resuscitation (CPR) is challenging. Besides the neurological examination, brain imaging, EEG, and somatosensory evoked potentials (SEP) are used to assess brain status [16, 30]. Blood biomarkers could provide additional independent information on brain damage on a molecular basis and could therefore be helpful to stratify patients according to their pro
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