Blood-based brain injury biomarkers tied to unfavorable outcomes at 1 year after pediatric cardiac arrest: JAMA

Blood-based brain injury biomarkers like neurofilament light (NfL), were linked to a poorer outcome 1 year after pediatric cardiac arrest as per a study that was published in the journal JAMA Network Open. 

There are limited validated tools available for clinicians to estimate long-term outcomes early after pediatric cardiac arrest. Tools like Blood-based brain-specific biomarkers may be helpful to assist in the outcome assessment. Hence researchers conducted a multicenter prospective cohort study to assess the association of blood-based brain injury biomarker concentrations with outcomes 1 year after pediatric cardiac arrest. The study was carried out in pediatric intensive care units at 14 academic referral centers in the US between May 16, 2017, and August 19, 2020. 

120 children aged 48 hours to 17 years who were resuscitated and admitted to an intensive care unit after cardiac arrest and those who had pre–cardiac arrest Pediatric Cerebral Performance Category scores of 1 to 3 points were taken in the study. The primary outcome was an unfavorable outcome like death or survival with a Vineland Adaptive Behavior Scales, third edition with a score of <70 points at 1 year after cardiac arrest. From days 1 to 3 biomarkers like Glial fibrillary acidic protein (GFAP), ubiquitin carboxyl-terminal esterase L1 (UCH-L1), neurofilament light (NfL), and tau concentrations were measured in blood samples after cardiac arrest. Multivariate logistic regression and area under the receiver operating characteristic curve (AUROC) analyses were performed to examine the association of each biomarker with outcomes on days 1 to 3. 

Key findings: 

• Among 120 participants,71 children (59.2%) were male with a median age was 1 year.
• A total of 5 children were Asian, 19 were Black, 81 were White, and 15 were of unknown race.
• 110 children had data on ethnicity, of whom 11 were Hispanic, and 99 were non-Hispanic.
• Overall, 70 children had a favorable outcome, and 50 children had an unfavorable outcome, including 43 deaths.
• On days 1 to 3 after cardiac arrest, concentrations of all 4 measured biomarkers were higher in children with an unfavorable vs a favorable outcome at 1 year.
• After covariate adjustment, NfL concentrations on day 1, 2 & 3; UCH-L1 concentrations on day 2 & 3; GFAP concentrations on day 2 & 3; and tau concentrations on day 1, 2 & 3 were associated with an unfavorable outcome.
• The AUROC models were significantly higher with vs without the addition of NfL on day 2 and day 3.  

Thus, the researchers concluded that blood-based brain injury biomarkers, especially NfL, were associated with an unfavorable outcome at 1 year after pediatric cardiac arrest. 

To read the full article, click here: 10.1001/jamanetworkopen.2022.30518 

Fink EL, Kochanek PM, Panigrahy A, et al. Association of Blood-Based Brain Injury Biomarker Concentrations With Outcomes After Pediatric Cardiac Arrest. JAMA Netw Open. 2022;5(9):e2230518. Published 2022 Sep 1.