Acute cardiac care & resuscitation
Brain injury markers in blood predict signs of hypoxic ischaemic encephalopathy on head computed tomography after cardiac arrest
Authors' conclusion
Biomarker levels can assess the likelihood of a patient presenting with HIE on CT
Study context
- Population
- Patients after OHCA with head computed tomography (CT) performed at 24–168 h post-arrest on clinical indication
- Participants
- 95 patients
- Comparison
- Blood brain injury markers for predicting hypoxic ischaemic encephalopathy (HIE) on head CT
- Outcome
- Prediction of HIE on head CT (visual evaluation), by biomarker levels
- Follow-up
- 48 h
Methodological detailsretrospective analysis within the Target Temperature Management after out-of-hospital cardiac arrest-trial, biomarkers prospectively collected
- Retrospective analysis within the Target Temperature Management after out-of-hospital cardiac arrest-trial
- Biomarkers prospectively collected
Performance
As reported in the abstract
AUC to predict HIE on CT · 48 h (CT performed at IQR 73-116 h)
| Test or model | AUC |
|---|---|
| Neuron specific enolase (NSE) | 0.82 (0.71-0.94) |
| Neurofilament light (NFL) | 0.79 (0.67-0.91) |
| Total-tau | 0.84 (0.74-0.95) |
| Glial fibrillary acidic protein (GFAP) | 0.79 (0.67-0.90) |
AUC
Neuron specific enolase (NSE)0.82 (0.71-0.94)
Neurofilament light (NFL)0.79 (0.67-0.91)
Total-tau0.84 (0.74-0.95)
Glial fibrillary acidic protein (GFAP)0.79 (0.67-0.90)
Further findings
AUC to predict HIE on CT, biomarkers at 24 h
- AUC range across biomarkers
- 0.72-0.81
NPV and PPV at Youden Index cut-off · 48 h
- NPV (levels below Youden Index excluded HIE)
- 77.3-91.7%
- PPV (levels above Youden Index predicted HIE)
- 73.3-83.7%
- NSE cut-off
- 48 ng/ml
Grey-white-matter ratio (GWR)
- Elevated biomarker levels irrespective of timepoint significantly correlated with lower GWR
- GWR calculated on Swedish subjects with original images available
Original publication
Brain injury markers in blood predict signs of hypoxic ischaemic encephalopathy on head computed tomography after cardiac arrest. Resuscitation. Published 20 December 2022. doi:10.
Summarised from the published abstract; every number is checked against it