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Ann Neurol. 2017 Nov;82(5):665-675. doi: 10.1002/ana.25067. Epub 2017 Nov 2.

Serum tau and neurological outcome in cardiac arrest.

Author information

1
Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden.
2
Department of Clinical Sciences, Neurology, Lund University, Skåne University Hospital, Lund, Sweden.
3
Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.
4
Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
5
Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom.
6
UK Dementia Research Institute, London, United Kingdom.
7
Department of Clinical Sciences, Anesthesia, and Intensive Care, Lund University, Helsingborg Hospital, Lund, Sweden.
8
Department of Clinical Sciences, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden.
9
Department of Clinical Sciences, Anesthesia, and Intensive Care, Lund University, Skåne University Hospital, Lund, Sweden.
10
Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
11
Department of Anesthesia and Intensive Care, Luxembourg Hospital Center, Luxembourg.
12
Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia.
13
Department of Cardiology B2142, Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
14
Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
15
Anesthesia and Intensive Care, Card. G. Panico Hospital Agency, Tricase, Italy.
16
Copenhagen Trial Unit, Center of Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark.
17
Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.

Abstract

OBJECTIVE:

To test serum tau as a predictor of neurological outcome after cardiac arrest.

METHODS:

We measured the neuronal protein tau in serum at 24, 48, and 72 hours after cardiac arrest in 689 patients in the prospective international Target Temperature Management trial. The main outcome was poor neurological outcome, defined as Cerebral Performance Categories 3-5 at 6 months.

RESULTS:

Increased tau was associated with poor outcome at 6 months after cardiac arrest (median = 38.5, interquartile range [IQR] = 5.7-245ng/l in poor vs median = 1.5, IQR = 0.7-2.4ng/l in good outcome, for tau at 72 hours, p < 0.0001). Tau improved prediction of poor outcome compared to using clinical information (p < 0.0001). Tau cutoffs had low false-positive rates (FPRs) for good outcome while retaining high sensitivity for poor outcome. For example, tau at 72 hours had FPR = 2% (95% CI = 1-4%) with sensitivity = 66% (95% CI = 61-70%). Tau had higher accuracy than serum neuron-specific enolase (NSE; the area under the receiver operating characteristic curve was 0.91 for tau vs 0.86 for NSE at 72 hours, p = 0.00024). During follow-up (up to 956 days), tau was significantly associated with overall survival. The accuracy in predicting outcome by serum tau was equally high for patients randomized to 33 °C and 36 °C targeted temperature after cardiac arrest.

INTERPRETATION:

Serum tau is a promising novel biomarker for prediction of neurological outcome in patients with cardiac arrest. It may be significantly better than serum NSE, which is recommended in guidelines and currently used in clinical practice in several countries to predict outcome after cardiac arrest. Ann Neurol 2017;82:665-675.

PMID:
28981963
PMCID:
PMC5725735
DOI:
10.1002/ana.25067
[Indexed for MEDLINE]
Free PMC Article

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