Investigation of the possibility of using ischemia-modified albumin as a novel and early prognostic marker in cardiac arrest patients after cardiopulmonary resuscitation

Background: Early and accurate prediction of survival to hospital discharge following resuscitation after cardiac arrest (CA) is a major challenge. Our aim was to investigate the levels of ischemia-modified albumin (IMA) and malondialdehyde (MDA) in CA patients and whether IMA levels are valuable early marker of post-cardiopulmonary resuscitation prognosis in CA patients. Methods: We enrolled 52 in-or out-of-hospital CA patients, with 47 healthy volunteers as the control group (CG). Blood samples were taken for IMA and MDA measurement at the beginning or within 5 min of commencement of CPR. The patients were classified according to the Glasgow Outcome Score (GOS) into a poor outcome group (POG) and a good outcome group (GOG). Results: Mean IMA levels were higher in POG (0.25 +/- 0.07 ABSU) than in GOG (0.19 +/- 0.07 ABSU, p = 0.002) and also than CG (0.16 +/- 0.04 ABSU, p = 0.0001). The IMA levels were not significantly higher in GOG than in CG (p = 0.32). The mean MDA levels in POG (0.77 +/- 0.27 nmol/ml) were comparable to the levels in GOG (0.75 +/- 0.18 nmol/ml, p > 0.05), but were significantly higher than in CG (0.60 +/- 0.15 nmol/ml, p = 0.001). MDA levels were not significantly higher in GOG than in CG (p = 0.06). The optimum cut-off point for IMA maximizing sensitivity and specificity was 0.235 ABSU, with sensitivity of 65.8% and specificity of 78.6%. The corresponding +PV and -PV were 85.3% and 45.8%, respectively. Conclusion: In conclusion, though the result may not be applied clinically in every patient, the ischemia-modified albumin may be a valuable prognostic marker in cardiac arrest patients following CPR. (C) 2009 Elsevier Ireland Ltd. All rights reserved.