Cerebrospinal Creatine Kinase BB Isoenzyme: A Biomarker for Predicting Outcome After Cardiac Arrest.

Autor: Johnson NJ; Department of Emergency Medicine, Harborview Medical Center, University of Washington School of Medicine, University of Washington, 325 Ninth Avenue, Box 359108, Seattle, WA, 98104, USA. nickj45@uw.edu.; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA. nickj45@uw.edu., Matin N; Barrow Neurological Institute, Phoenix, AZ, USA., Singh A; Department of Neurology, University of Florida, Gainesville, FL, USA., Davis AP; Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA., Liao HC; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA., Town JA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA., Tirschwell DL; Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA., Nash MG; Center for Biomedical Statistics, University of Washington, Seattle, WA, USA., Longstreth WT Jr; Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA., Khot SP; Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Jazyk: angličtina
Zdroj: Neurocritical care [Neurocrit Care] 2024 Jul 02. Date of Electronic Publication: 2024 Jul 02.
DOI: 10.1007/s12028-024-02037-8
Abstrakt: Background: Cerebrospinal fluid creatine kinase BB isoenzyme (CSF CK-BB) after cardiac arrest (CA) has been shown to have a high positive predictive value for poor neurological outcome, but it has not been evaluated in the setting of targeted temperature management (TTM) and modern CA care. We aimed to evaluate CSF CK-BB as a prognostic biomarker after CA.
Methods: We performed a retrospective cohort study of patients with CA admitted between 2010 and 2020 to a three-hospital health system who remained comatose and had CSF CK-BB assayed between 36 and 84 h after CA. We examined the proportion of patients at hospital discharge who achieved favorable or intermediate neurological outcome, defined as Cerebral Performance Category score of 1-3, compared with those with poor outcome (Cerebral Performance Category score 4-5) for various CSF CK-BB thresholds. We also evaluated additive value of bilateral absence of somatosensory evoked potentials (SSEPs).
Results: Among 214 eligible patients, the mean age was 54.7 ± 4.8 years, 72% of patients were male, 33% were nonwhite, 17% had shockable rhythm, 90% were out-of-hospital CA, and 83% received TTM. A total of 19 (9%) awakened. CSF CK-BB ≥ 230 U/L predicted a poor outcome at hospital discharge, with a specificity of 100% (95% confidence interval [CI] 82-100%) and sensitivity of 69% (95% CI 62-76%). When combined with bilaterally absent N20 response on SSEP, specificity remained 100% while sensitivity increased to 80% (95% CI 73-85%). Discordant CK-BB and SSEP findings were seen in 13 (9%) patients.
Conclusions: Cerebrospinal fluid creatine kinase BB isoenzyme levels accurately predicted poor neurological outcome among CA survivors treated with TTM. The CSF CK-BB cutoff of 230 U/L optimizes sensitivity to 69% while maintaining a specificity of 100%. CSF CK-BB could be a useful addition to multimodal neurological prognostication after CA.
(© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)
Databáze: MEDLINE
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