• Alice Lagebrant, Margareta Lang, Niklas Nielsen, Kaj Blennow, Josef Dankiewicz, Hans Friberg, Christian Hassager, Janneke Horn, Jesper Kjaergaard, Mikael A Kuiper, Niklas Mattsson-Carlgren, Tommaso Pellis, Christian Rylander, Roger Sigmund, Pascal Stammet, Johan Undén, Henrik Zetterberg, Matt P Wise, Tobias Cronberg, and Marion Moseby-Knappe.
• Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden. Electronic address: alice.lagebrant@med.lu.se.
• Resuscitation. 2023 Mar 1; 184: 109668109668.

Background/AimSigns of hypoxic ischaemic encephalopathy (HIE) on head computed tomography (CT) predicts poor neurological outcome after cardiac arrest. We explore whether levels of brain injury markers in blood could predict the likelihood of HIE on CT.MethodsRetrospective analysis of CT performed at 24-168 h post cardiac arrest on clinical indication within the Target Temperature Management after out-of-hospital cardiac arrest-trial. Biomarkers prospectively collected at 24- and 48 h post-arrest were analysed for neuron specific enolase (NSE), neurofilament light (NFL), total-tau and glial fibrillary acidic protein (GFAP). HIE was assessed through visual evaluation and quantitative grey-white-matter ratio (GWR) was retrospectively calculated on Swedish subjects with original images available.ResultsIn total, 95 patients were included. The performance to predict HIE on CT (performed at IQR 73-116 h) at 48 h was similar for all biomarkers, assessed as area under the receiving operating characteristic curve (AUC) NSE 0.82 (0.71-0.94), NFL 0.79 (0.67-0.91), total-tau 0.84 (0.74-0.95), GFAP 0.79 (0.67-0.90). The predictive performance of biomarker levels at 24 h was AUC 0.72-0.81. At 48 h biomarker levels below Youden Index accurately excluded HIE in 77.3-91.7% (negative predictive value) and levels above Youden Index correctly predicted HIE in 73.3-83.7% (positive predictive value). NSE cut-off at 48 h was 48 ng/ml. Elevated biomarker levels irrespective of timepoint significantly correlated with lower GWR.ConclusionBiomarker levels can assess the likelihood of a patient presenting with HIE on CT and could be used to select suitable patients for CT-examination during neurological prognostication in unconscious cardiac arrest patients.Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

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