Ubiquitin C‐terminal hydrolase L1 after out‐of‐hospital cardiac arrest

Abstract

Background We studied the prognostic ability of serum ubiquitin C‐terminal hydrolase L1 (UCH‐L1) after out‐of‐hospital cardiac arrest (OHCA), compared to that of neuron‐specific enolase (NSE). Methods In this post‐hoc analysis of the FINNRESUSCI study, we measured serum concentrations of UCH‐L1 in 249 OHCA patients treated in 21 Finnish intensive care units in 2010–2011. We evaluated the ability of UCH‐L1 to predict unfavourable outcome at 12 months (defined as cerebral performance category 3–5) by assessing the area under the receiver operating characteristic curve (AUROC), in comparison with NSE. Results The concentrations of UCH‐L1 were higher in patients with unfavourable outcome than for those with favourable outcome: median concentration 10.8 ng/mL (interquartile range, 7.5–18.5 ng/mL) versus 7.8 ng/mL (5.9–11.8 ng/mL) at 24 h (p < .001), and 16.2 ng/mL (12.2–27.7 ng/mL) versus 11.5 ng/mL (9.0–17.2 ng/mL) (p < .001) at 48 h after OHCA. For UCH‐L1 as a 12‐month outcome predictor, the AUROC was 0.66 (95% confidence interval, 0.60–0.73) at 24 h and 0.66 (0.59–0.74) at 48 h. For NSE, the AUROC was 0.66 (0.59–0.73) at 24 h and 0.72 (0.65–0.80) at 48 h. The prognostic ability of UCH‐L1 was not different from that of NSE at 24 h (p = .82) and at 48 h (p = .23). Conclusion Concentrations of UCH‐L1 in serum were higher in patients with unfavourable outcome than in those with favourable outcome. However, the ability of UCH‐L1 to predict unfavourable outcome after OHCA was only moderate and not superior to that of NSE.

Higher levels of brain injury biomarker tau are associated with unfavorable outcomes in patients supported with ECMO following cardiac arrest

“… 33 In a post hoc analysis of 249 adults who suffered out of hospital cardiac arrest, UCHL1 had significantly higher levels in patients with poor vs good neurofunctional outcomes at one year, however its predictive value was only moderate. 34 While UCHL1 has been associated with degree of brain injury and outcomes in other studies, values for UCHL1 were outside of detectable limits in our patient samples and this biomarker was deferred from further analysis. Further studies in children on ECMO should be undertaken with UCHL1 assays of higher sensitivity.…”

“…Further studies in children on ECMO should be undertaken with UCHL1 assays of higher sensitivity. Prior research in other patient populations with cardiac arrest or traumatic brain injury conducted using assays with a lower value for the lower limit of detection (e.g., 160 pg/mL, 34 30 pg/mL, 35 or 5.45 pg/mL 20 ) had positive findings, and thus it is possible that the negative findings in our study are in fact false negative and driven by the performance characteristics of the assay used.…”