Madlaina Widmer1, Emanuel B Thommen1, Christoph Becker2, Katharina Beck1, Alessia M Vincent1, Sebastian Perrig1, Annalena Keller1, Luca Bernasconi3, Peter Neyer3, Stephan Marsch4, Hans Pargger4, Raoul Sutter5, Kai Tisljar6, Sabina Hunziker7. 1. Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland. 2. Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland; Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland; Emergency Department, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. 3. Institute of Laboratory Medicine, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland. 4. Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland; Departement of Intensive Care, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. 5. Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland; Departement of Intensive Care, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Neurology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. 6. Departement of Intensive Care, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. 7. Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland; Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland; Departement of Intensive Care, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. Electronic address: Sabina.hunziker@usb.ch.
Abstract
PURPOSE: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality, yet the prediction of its outcome remains challenging. Serum Acyl Carnitines (ACs), a biomarker of beta-oxidation, have been associated with cardiovascular events. We evaluated the association of different AC species with mortality and neurological outcome in a cohort of OHCA patients. MATERIAL AND METHODS: We consecutively included OHCA patients in this prospective observational study upon admission to the intensive care unit. We studied the association of thirty-nine different ACs measured at admission and 30-day mortality (primary endpoint), as well as neurological outcome at hospital discharge (secondary endpoint) using the Cerebral Performance Category scale. Multivariate models were adjusted for age, gender, comorbidities and shock markers. RESULTS: Of 281 included patients, 137 (48.8%) died within 30 days and of the 144 survivors (51.2%), 15 (10.4%) had poor neurological outcome. While several ACs were associated with mortality, AC C2 had the highest prognostic value for mortality (fully-adjusted odds ratio 4.85 (95%CI 1.8 to 13.06, p < .01), area under curve (AUC) 0.65) and neurological outcome (fully-adjusted odds ratio 3.96 (95%CI 1.47 to 10.66, p < .01), AUC 0.63). CONCLUSIONS: ACs are interesting surrogate biomarkers that are associated with mortality and poor neurological outcome in patients after OHCA and may help to improve the understanding of pathophysiological mechanisms and risk stratification.
PURPOSE: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality, yet the prediction of its outcome remains challenging. Serum Acyl Carnitines (ACs), a biomarker of beta-oxidation, have been associated with cardiovascular events. We evaluated the association of different AC species with mortality and neurological outcome in a cohort of OHCA patients. MATERIAL AND METHODS: We consecutively included OHCA patients in this prospective observational study upon admission to the intensive care unit. We studied the association of thirty-nine different ACs measured at admission and 30-day mortality (primary endpoint), as well as neurological outcome at hospital discharge (secondary endpoint) using the Cerebral Performance Category scale. Multivariate models were adjusted for age, gender, comorbidities and shock markers. RESULTS: Of 281 included patients, 137 (48.8%) died within 30 days and of the 144 survivors (51.2%), 15 (10.4%) had poor neurological outcome. While several ACs were associated with mortality, AC C2 had the highest prognostic value for mortality (fully-adjusted odds ratio 4.85 (95%CI 1.8 to 13.06, p < .01), area under curve (AUC) 0.65) and neurological outcome (fully-adjusted odds ratio 3.96 (95%CI 1.47 to 10.66, p < .01), AUC 0.63). CONCLUSIONS:ACs are interesting surrogate biomarkers that are associated with mortality and poor neurological outcome in patients after OHCA and may help to improve the understanding of pathophysiological mechanisms and risk stratification.
Authors: René Blatter; Simon A Amacher; Chantal Bohren; Christoph Becker; Katharina Beck; Sebastian Gross; Kai Tisljar; Raoul Sutter; Stephan Marsch; Sabina Hunziker Journal: Ann Intensive Care Date: 2022-08-17 Impact factor: 10.318