• Bergþóra Þorgeirsdóttir, Theodor Sievert, Anna Lybeck, Nicholas J Ashton, Kaj Blennow, Henrik Zetterberg, Hans Friberg, and Attila Frigyesi.
• Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden; Skåne University Hospital, Department of Intensive and Perioperative Care, SE-20502 Malmö, Sweden. Electronic address: bergthora.thorgeirsdottir@med.lu.se.
• Resuscitation. 2024 Dec 3: 110450110450.

PurposeWe studied the promising Alzheimer biomarker plasma tau phosphorylated at threonine 231 (p-tau231) in a cohort of cardiac arrest patients who survived to intensive care to predict long-term neurological outcomes. We also compared it to total tau (t-tau), which has demonstrated predictive abilities of neurological outcome post-cardiac arrest.MethodsThis observational multicentre cohort study included 425 patients admitted to intensive care after cardiac arrest. Plasma p-tau231 was retrospectively analysed at admission, 12 and 48 h after cardiac arrest. The association of the Cerebral Performance Category (CPC) with p-tau231 was analysed with a one-way analysis of variance (ANOVA). CPC was modelled using multivariate ordinal logistic regression, and the biomarkers' prognostic performance was assessed by the area under the receiver operating characteristic curve (AUC).ResultsIncreasing p-tau231 levels were significantly associated with worse CPC (p < 0.001). P-tau231 showed moderate prognostic abilities (AUC: 0.69 on admission, 0.72 at 12 h, and 0.71 at 48 h) for all patients but did not improve neurological prognostication after adjusting for clinical covariates. Elevated levels of t-tau were significantly associated with a worse outcome at all time points (p < 0.001). T-tau significantly improved neurological prognosis at 48 h after adjusting for covariates (AUC: 0.95, 95 % CI 0.93-0.98, p < 0.001) compared to the clinical covariate reference model (AUC: 0.88, 95 % CI 0.84-0.93).ConclusionsAlthough p-tau231 showed moderate neurological prognostic ability, t-tau was a stronger predictor, particularly at 48 h, even after adjusting for clinical covariates.Copyright © 2024. Published by Elsevier B.V.

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