Abstract 15423: Plasma Heme oxygenase-1 Predicts Mortality and Neurological Outcome after Out-of-Hospital Ventricular Fibrillation
Introduction: Heme oxygenase-1 (HO-1) is a stress inducible enzyme implicated in both neuroprotection and cardioprotection. Plasma HO-1 has been shown to increase in critically ill patients and associate with organ dysfunction, but the role of HO-1 in cardiac arrest patients is not known.
Hypothesis: We investigated the association of HO-1 plasma levels with the outcome of out-of-hospital cardiac arrest (OHCA) patients.
Methods: A 12-month prospective observational multicenter study in 21 Finnish intensive care units (ICU’s) (the Finnresusci study) in 2010-2011. A subgroup of OHCA patients with initial shockable rhythm was included in this study. Plasma HO-1 was measured at admission and 24 h after ICU admission (day 1) using HO-1 enzyme-linked immunoassay (HO-1 EIA kit, Enzo Life Sciences). The association of plasma HO-1 with time to return of spontaneous circulation (ROSC), APACHE, SAPSII and SOFA scores, ICU mortality, hospital mortality, 90 day mortality and 12-month Cerebral Performance Category (CPC) were analyzed. The primary outcomes were 90-day mortality and 12-month neurological outcome.
Results: A total of 143 OCHA patients resuscitated from ventricular fibrillation were included in the study. Higher admission and day 1 plasma HO-1 correlated with prolonged time to ROSC (admission, p=0.002, 0.256; day 1, p=0.003, 0.246). Plasma HO-1 also correlated significantly with APACHE (admission, p=0.011, 0.212; day 1, p=0.003, 0.249) and SAPSII (day 1, p=0.022, 0.191) scores. No correlation between HO-1 concentrations and SOFA score was found. The total mortality was 47 out of 143 patients (33%). Greater 90-day and hospital mortalities were associated with higher HO-1 concentrations at admission (90-day mortality, p=0.017; hospital mortality, p=0.039) and day 1 (90-day mortality, p=0.026; hospital mortality, p=0.048). In addition, poor neurological outcome (CPC 3-5) was associated with higher HO-1 plasma levels at admission (p=0.024). The area under the curve for prediction of poor neurological outcome was 0.611.
Conclusions: We show here for the first time that HO-1 plasma concentrations are associated with ROSC, mortality and long-term neurological outcome in OHCA patients. Plasma HO-1 may aid early prediction of outcome after OHCA.
Author Disclosures: J. Siren: None. J. Vaahersalo: None. V. Pettilä: None. I. Tikkanen: None. P. Lakkisto: None.
- © 2014 by American Heart Association, Inc.