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Erschienen in:
01.10.2014 | Original
Secretoneurin as a marker for hypoxic brain injury after cardiopulmonary resuscitation
Erschienen in: Intensive Care Medicine | Ausgabe 10/2014
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Purpose
The neuropeptide secretoneurin (SN) shows widespread distribution in the brain. We evaluated whether SN is elevated after cardiopulmonary resuscitation (CPR) and could serve as a potential new biomarker for hypoxic brain injury after CPR.
Methods
This was a prospective observational clinical study. All patients admitted to a tertiary medical intensive care unit after successful CPR with expected survival of at least 24 h were consecutively enrolled from September 2008 to April 2013. Serum SN and neuron-specific enolase were determined in 24 h intervals starting with the day of CPR for 7 days. Neurological outcome was assessed with the Cerebral Performance Categories Scale (CPC) at hospital discharge.
Results
A total of 134 patients were included with 49 % surviving to good neurological outcome (CPC 1–2). SN serum levels peaked within the first 24 h showing on average a sixfold increase above normal. SN levels were significantly higher in patients with poor (CPC 3–5) than in patients with good neurological outcome [0–24 h: 75 (43–111) vs. 38 (23–68) fmol/ml, p < 0.001; 24–48 h: 45 (24–77) vs. 23 (16–39) fmol/ml, p < 0.001]. SN determined within the first 48 h showed a receiver operating characteristic (ROC) area under the curve (AUC) of 0.753 (0.665–0.841). NSE in the first 72 h had a ROC-AUC of 0.881 (0.815–0.946). When combining the two biomarkers an AUC of 0.925 (0.878–0.972) for outcome prediction could be reached.
Conclusions
SN is a promising early biomarker for hypoxic brain injury. Further studies will be required for confirmation of these results.