Cerebrospinal fluid biomarkers in cardiac arrest survivors

Aim: The aim of this study was to investigate the levels of various cerebrospinal fluid (CSF) biomarkers related to neuronal damage, inflammation and amyloid beta (A beta) metabolism in patients resuscitated after an out-of-hospital cardiac arrest (CA). Methods: CSF levels of neurofilament light protein (NFL), total tau (T-tau), hyperphosphorylated tau (P-tau), YKL-40, A beta 38, A beta 40, A beta 42, soluble amyloid precursor protein alpha and beta (sAPP alpha and sAPP beta) were measured in 21 patients approximately two weeks after CA and in 21 age-matched neurologically healthy controls. The biomarker levels were also compared between patients with good and poor long-term clinical outcome according to Glasgow Outcome Scale (GOS), activities of daily living (ADL) and mini-mental state examination (MMSE), measuring neurologic function, daily functioning and cognitive function, respectively. Results: Patients with CA had a very marked increase in the CSF levels of NFL, T-tau and YKL-40 as compared with controls. The levels were increased at about 1200, 700 and 100%, respectively. NFL and T-tau were significantly higher in patients with poor outcome according to all three outcome measures. Patients with poor outcome according to GOS and ADL had higher levels of YKL-40. Levels of A beta 38, A beta 40, A beta 42, sAPP alpha and sAPP beta were lower in patients with a low MMSE score. P-tau was not significantly altered. Conclusions: Biomarkers reflecting neuronal damage and inflammation, but not so much A beta metabolism, were significantly altered in patients after a CA, and the changes were more pronounced in the groups with poor outcome. This calls for future larger studies to determine the prognostic potential of these biomarkers. (C) 2013 Elsevier Ireland Ltd. All rights reserved.