Abstract 154: Serum Biomarkers of Brain Injury Predict Outcome After Pediatric Cardiac Arrest
Morbidity and mortality in children with return of pulses after cardiac arrest (CA) largely result from neurologic failure. Serum biomarkers of brain injury can potentially measure injury to neurons (neuron specific enolase [NSE]), astrocytes (S100b), and axons (myelin basic protein [MBP]). This study tested the hypothesis that a panel of serum biomarkers can predict outcome from pediatric CA with high specificity and sensitivity. Blood samples were collected twice daily (days 1-4) and once on day 7 after CA from children who were enrolled in either a prospective, randomized clinical trial comparing different durations of mild therapeutic hypothermia or in an observational study. NSE, S100b, and MBP were measured using commercially available ELISAs. Demographics, details of the CA and resuscitation, and Pediatric Cerebral Performance Category (PCPC) pre-CA and at hospital discharge were collected. Initial, median, and peak biomarker concentrations were compared by good (PCPC 1-3) or poor (PCPC 4-6) outcome using Wilcoxon rank sum, and ROC analyses were performed using logistic regression. Thirty-three children (52% female; median age 1.6 (range 1 wk-17yr) were enrolled and 18 (56%) died. Most CA were due to asphyxia (79%), occurred outside the hospital (70%), and had asystole or PEA as the first monitored rhythm (88%). Median and peak values of all 3 biomarkers and initial S100b predicted outcome (Table). Peak NSE, S100b, and MBP concentrations occurred at 38 h (IQR 20-69h), 19 h (7-34h), and 66 h (29-122h) after CA. Area under the curve for good or poor outcome was 0.83 for initial, and 0.93 for median and peak values of the biomarker panel. A panel of serum biomarkers of brain injury was able to discriminate outcome of children with CA at hospital discharge with good to excellent accuracy. NSE, S100b, and MBP may aid monitoring of brain injury and response to therapies.
- © 2011 by American Heart Association, Inc.