Elevated plasma heparin-binding protein is associated with early death after resuscitation from cardiac arrest

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http://hdl.handle.net/10138/166669

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Ristagno , G , Masson , S , Tiainen , M , Bendel , S , Bernasconi , R , Varpula , T M , Milani , V , Vaahersalo , J , Magnoli , M , Spanuth , E , Barlera , S , Latini , R , Hoppu , S , Pettila , V , Skrifvars , M & FINNRESUSCI Study Grp 2016 , ' Elevated plasma heparin-binding protein is associated with early death after resuscitation from cardiac arrest ' , Critical Care , vol. 20 , 251 . https://doi.org/10.1186/s13054-016-1412-4

Title: Elevated plasma heparin-binding protein is associated with early death after resuscitation from cardiac arrest
Author: Ristagno, Giuseppe; Masson, Serge; Tiainen, Marjaana; Bendel, Stepani; Bernasconi, Roberto; Varpula, Tero M; Milani, Valentina; Vaahersalo, Jukka; Magnoli, Michela; Spanuth, Eberhard; Barlera, Simona; Latini, Roberto; Hoppu, Sanna; Pettila, Ville; Skrifvars, Markus; FINNRESUSCI Study Grp
Contributor: University of Helsinki, Department of Neurosciences
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Anestesiologian yksikkö
University of Helsinki, Clinicum
University of Helsinki, Clinicum
Date: 2016-08-07
Language: eng
Number of pages: 8
Belongs to series: Critical Care
ISSN: 1466-609X
URI: http://hdl.handle.net/10138/166669
Abstract: Background: An intense systemic inflammatory response is observed following reperfusion after cardiac arrest. Heparin-binding protein (HBP) is a granule protein released by neutrophils that intervenes in endothelial permeability regulation. In the present study, we investigated plasma levels of HBP in a large population of patients resuscitated from out-of-hospital cardiac arrest. We hypothesized that high circulating levels of HBP are associated with severity of post-cardiac arrest syndrome and poor outcome. Methods: Plasma was obtained from 278 patients enrolled in a prospective multicenter observational study in 21 intensive care units (ICU) in Finland. HBP was assayed at ICU admission and 48 h later. Multiple organ dysfunction syndrome (MODS) was defined as the 24 h Sequential Organ Failure Assessment (SOFA) score >= 12. ICU death and 12-month Cerebral Performance Category (CPC) were evaluated. Multiple linear and logistic regression tests and receiver operating characteristic curves with area under the curve (AUC) were performed. Results: Eighty-two percent of patients (229 of 278) survived to ICU discharge and 48 % (133 of 276) to 1 year with a favorable neurological outcome (CPC 1 or 2). At ICU admission, median plasma levels of HBP were markedly elevated, 15.4 [9.6-31.3] ng/mL, and persisted high 48 h later, 14.8 [9.8-31.1] ng/mL. Admission levels of HBP were higher in patients who had higher 24 h SOFA and cardiovascular SOFA score (p <0.0001) and in those who developed MODS compared to those who did not (29.3 [13.7-60.1] ng/mL vs. 13.6 [9.1-26.2] ng/mL, p <0.0001; AUC = 0.70 +/- 0.04, p = 0.0001). Admission levels of HBP were also higher in patients who died in ICU (31.0 [17.7-78.2] ng/mL) compared to those who survived (13.5 [9.1-25.5] ng/mL, p <0.0001) and in those with an unfavorable 12-month neurological outcome compared to those with a favorable one (18.9 [11.3-44.3] ng/mL vs. 12.8 [8.6-30.4] ng/mL, p <0.0001). Admission levels of HBP predicted early ICU death with an AUC of 0.74 +/- 0. 04 (p <0.0001) and were independently associated with ICU death (OR [95 %CI] 1.607 [1.076-2.399], p = 0.020), but not with unfavorable 12-month neurological outcome (OR [95 %CI] 1.154 [0.834-1.596], p = 0.387). Conclusions: Elevated plasma levels of HBP at ICU admission were independently associated with early death in ICU.
Subject: Cardiac arrest
Heparin-binding protein
Post resuscitation
Outcome
SUCCESSFUL CARDIOPULMONARY-RESUSCITATION
SYSTEMIC INFLAMMATORY RESPONSE
THERAPEUTIC HYPOTHERMIA
ORGAN DYSFUNCTION
SPONTANEOUS CIRCULATION
SURVIVAL
CARE
SEPSIS
INFECTIONS
SECRETION
3121 General medicine, internal medicine and other clinical medicine
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