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Post-cardiac arrest serum levels of glial fibrillary acidic protein for predicting neurological outcome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Education in Nursing.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Education in Nursing.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
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2014 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 12, 1654-1661 p.Article in journal (Refereed) Published
Abstract [en]

AIM OF THE STUDY: To investigate serum levels of glial fibrillary acidic protein (GFAP) for evaluation of neurological outcome in cardiac arrest (CA) patients and compare GFAP sensitivity and specificity to that of more studied biomarkers neuron-specific enolas (NSE) and S100B.METHOD: A prospective observational study was performed in three hospitals in Sweden during 2008-2012. The participants were 125 CA patients treated with therapeutic hypothermia (TH) to 32-34°C for 24hours. Samples were collected from peripheral blood (n=125) and the jugular bulb (n=47) up to 108hours post-CA. GFAP serum levels were quantified using a novel, fully automated immunochemical method. Other biomarkers investigated were NSE and S100B. Neurological outcome was assessed using the Cerebral Performance Categories scale (CPC) and dichotomized into good and poor outcome.RESULTS: GFAP predicted poor neurological outcome with 100% specificity and 14-23% sensitivity at 24, 48 and 72hours post-CA. The corresponding values for NSE were 27-50% sensitivity and for S100B 21-30% sensitivity when specificity was set to 100%. A logistic regression with stepwise combination of the investigated biomarkers, GFAP, did not increase the ability to predict neurological outcome. No differences were found in GFAP, NSE and S100B levels when peripheral and jugular bulb blood samples were compared.CONCLUSION: Serum GFAP increase in patients with poor outcome but did not show sufficient sensitivity to predict neurological outcome after CA. Both NSE and S100B were shown to be better predictors. The ability to predict neurological outcome did not increased when combining the three biomarkers.

Place, publisher, year, edition, pages
2014. Vol. 85, no 12, 1654-1661 p.
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-229757DOI: 10.1016/j.resuscitation.2014.09.007ISI: 000346603700010PubMedID: 25260722OAI: oai:DiVA.org:uu-229757DiVA: diva2:739452
Available from: 2014-08-21 Created: 2014-08-12 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Post-Cardiac Arrest Care: Therapeutic Hypothermia, Patient Outcomes and Relatives’ Experiences
Open this publication in new window or tab >>Post-Cardiac Arrest Care: Therapeutic Hypothermia, Patient Outcomes and Relatives’ Experiences
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the thesis was to study post-resuscitation care of cardiac arrest (CA) patients with a focus on therapeutic hypothermia treatment, outcomes up to six months post-CA and relatives’ experiences during the hospital stay.

In Paper I, the aim was to asses effectiveness of hypothermia treatment with cold, 4°C, intravenous crystalloid infusion combined with ice packs. In conclusion, the described cooling method was found to be useful for inducing and maintaining hypothermia, allowed good temperature control during rewarming and to be feasible in clinical practice.

The aim in Paper II was to investigate biomarkers and the association of serum glial fibrillary acidic protein (GFAP) levels with outcome, and to compare GFAP with neuron-specific enolas (NSE) and S100B. The result showed increased GFAP levels in the poor outcome group, but did not show sufficient sensitivity to predict neurological outcome. Both NSE and S100B were shown to be better predictors. A combination of the investigated biomarkers did not increase the ability to predict neurological outcome.

In Paper III, the aim was to investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months post-CA. There was improvement over time in HRQoL, but changes over time in anxiety and depression were not found. Physical problems seemed to affect HRQoL more than psychological problems. The results also indicate that the less anxiety and depression patients perceive, the better their HRQoL.

In the fourth paper, the aim was to describe relatives’ experiences during the next of kin’s hospital stay after surviving a CA. The analysis resulted in three themes: The first period of chaos, Feeling secure in a difficult situation, and Living in a changed existence.

In conclusion, the results of the thesis have helped to improve knowledge within the areas studied and reveal aspects that should be taken into account in the overall treatment of this group of patients. The thesis have also shown the importance of developing an overall view and establishing a chain of care from an individual’s CA until follow-up for both the patient and his/her relatives.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 78 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1021
Keyword
cardiac arrest, therapeutic hypothermia, prognostication, outcome, quality of life, relatives
National Category
Anesthesiology and Intensive Care
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-229758 (URN)978-91-554-9009-6 (ISBN)
Public defence
2014-10-10, Enghoffsalen, ingång 50 bv., Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-09-18 Created: 2014-08-12 Last updated: 2015-01-22

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Larsson, Ing-MarieWallin, EwaKristofferzon, Marja-LeenaRubertsson, Sten

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