Abstract P63: Choline for Prediction of Short-term and Long-term Mortality in Patients With Cardiopulmonary Arrest and Acute Coronary Syndrome
Background and Objectives After cardiac arrest choline is released from ischemic tissues into plasma with a secondary uptake into blood cells. Stimulation of phopholipase D associated with vascular injury and inflammation causes an additional intracellular increase of choline in blood cells. However the prognostic value of choline in this specific setting is unknown and we therefore evaluated plasma choline and whole blood choline as novel markers for early outcome prediction in patients with acute coronary syndrome and successful resuscitation after cardiac arrest.
Methods In 15 adult patients with successful resuscitation after cardiac arrest and acute coronary syndrome plasma choline and whole blood choline was measured 30–90 min after restoration of spontaneous circulation (ROSC) using high-performance-liquid-chromatography mass spectrometry. Follow-up for all cause mortality was performed after 30 days (short-term) and after 4.6 years (long-term).
Results All cause mortality in this patient population was 20% (short-term) and 66.7% (long-term). In cut-off independent ROC curve analysis plasma choline was predictive for short-term mortality (area under the curve [AUC] 0.89; p=0.05) but not for long-term mortality (AUC 0.58; p=n.s.). Whole blood choline was not significantly predictive for short term mortality (AUC 0.72, p=0.28) but significantly predictive for long-term mortality (AUC 0.84; p=0.04). With ROC-curve based optimized cut-offs whole blood choline (>=40.0 μmol/L) was a strong predictor for long-term mortality with a hazard ratio of 8.4 (log rank p=0.002). Elevated plasma choline levels (>=36.6 μmol) were also associated with an increased long-term mortality (hazard ratio of 4.7; log rank p=0.01).
Conclusion Whole blood and plasma choline represent new potential biomarkers for early prediction of mortality after cardiac arrest in acute coronary syndromes.