Study Unveils Promising Biomarkers for Neurological Prognosis After Cardiac Arrest

The primary reason for mortality in patients who stay in a coma following a cardiac arrest is the withdrawal of life support (WLST) because of an anticipated unfavorable neurological prognosis. Numerous studies are focused on enhancing neuroprognostic techniques to prevent unnecessary care in patients who are unlikely to recover. Recent study examined the potential Alzheimer's disease biomarker plasma tau phosphorylated at threonine 231 (p-tau231) in a group of cardiac arrest survivors in intensive care with the goal of forecasting long-term neurological results. Tau phosphorylated at threonine 231 (p-tau231) and total tau (t-tau) were investigated as biomarkers for predicting long-term neurological outcomes in cardiac arrest patients admitted to intensive care in a multicenter study. This study included 425 patients and analyzed plasma p-tau231 levels at admission, 12 hours, and 48 hours post-cardiac arrest. The Cerebral Performance Category (CPC) was used to assess neurological outcomes.

Results Analysi

The results showed that increasing p-tau231 levels were associated with worse CPC outcomes, with moderate prognostic abilities (AUC: 0.69 at admission, 0.72 at 12 hours, and 0.71 at 48 hours). However, p-tau231 did not significantly improve neurological prognosis after adjusting for clinical covariates. Elevated t-tau levels were significantly associated with worse outcomes at all time points and notably improved neurological prognosis at 48 hours (AUC: 0.95) even after adjusting for covariates.

Comparative Analysis

The study highlighted that p-tau231, while showing some predictive ability, was not as strong a predictor as t-tau, especially at the 48-hour mark. T-tau demonstrated biphasic distribution over time, with higher levels in the poor outcome group at admission, decreasing at 12 hours, and sharply increasing at 48 hours. T-tau was a robust independent predictor of poor neurological prognosis, particularly at 48 hours post-cardiac arrest, surpassing p-tau231 in predictive strength. The potential of tau biomarkers, specifically t-tau, in predicting neurological outcomes post-cardiac arrest suggests their clinical significance. While p-tau231 showed moderate predictive abilities, t-tau emerged as a stronger and more reliable biomarker for long-term neurological outcomes. This study contributes to understanding the prognostic value of tau biomarkers, emphasizing the importance of early and accurate prognostication in cardiac arrest patients to guide clinical decision-making and potentially avoid futile care.

Conclusion

Despite the moderate predictive ability of p-tau231, t-tau proved to be a superior predictor of poor neurological outcomes, especially at 48 hours post-cardiac arrest. The study underscores the potential of t-tau as a valuable biomarker for long-term neurological prognosis in cardiac arrest patients, highlighting the need for further research to validate and optimize the use of biomarkers in this critical clinical setting.

Key Points

- Tau phosphorylated at threonine 231 (p-tau231) and total tau (t-tau) were investigated as biomarkers for predicting long-term neurological outcomes in cardiac arrest patients.

- The study included 425 patients and analyzed plasma p-tau231 levels at admission, 12 hours, and 48 hours post-cardiac arrest, using the Cerebral Performance Category (CPC) to assess neurological outcomes.

- Increasing p-tau231 levels were associated with worse CPC outcomes, with moderate prognostic abilities (AUC: 0.69 at admission, 0.72 at 12 hours, and 0.71 at 48 hours), but it did not significantly improve neurological prognosis after adjusting for clinical covariates.

- Elevated t-tau levels were significantly associated with worse outcomes at all time points and notably improved neurological prognosis at 48 hours (AUC: 0.95) even after adjusting for covariates.

- T-tau demonstrated biphasic distribution over time, with higher levels in the poor outcome group at admission, decreasing at 12 hours, and sharply increasing at 48 hours, being a robust independent predictor of poor neurological prognosis, particularly at 48 hours post-cardiac arrest, surpassing p-tau231 in predictive strength.

- T-tau emerged as a stronger and more reliable biomarker for long-term neurological outcomes post-cardiac arrest compared to p-tau231, underscoring its potential clinical significance and the need for further research in optimizing the use of biomarkers in cardiac arrest patients.

Reference –

BergþóRa ÞOrgeirsdóTtir et al. (2024). Plasma Phosphorylated Tau (P-Tau231) And Total Tau (T-Tau) As Prognostic Markers Of Neurological Outcome After Cardiac Arrest - A Multicentre Study.. *Resuscitation*, 110450 . https://doi.org/10.1016/j.resuscitation.2024.110450.