Procalcitonin and Presepsin as Prognostic Markers After Out-of-Hospital Cardiac Arrest

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Abstract

Background:

Patients resuscitated from cardiac arrest commonly develop an inflammatory response called post-cardiac arrest syndrome that clinically resembles septic shock.

Background:

Procalcitonin and presepsin are associated with inflammation. We hypothesized that these biomarkers reflect the severity of post-cardiac arrest syndrome and predict short-term haemodynamical instability and long-term neurological outcome after cardiac arrest.

Methods:

As a subcohort analysis of a prospective, observational, multi-centre study “FINNRESUSCI”, we obtained plasma from 277 intensive care unit (ICU) patients treated following out-of-hospital cardiac arrest (OHCA). Procalcitonin and presepsin levels were measured 0 to 6 hours from ICU admission and 24, 48 and 96 hours thereafter. We defined poor outcome as a 12-month Cerebral Performance Category of 3 to 5. We tested statistical associations between biomarkers and haemodynamical parameters and outcome with regression models.

Results:

Plasma procalcitonin had best predictive value for 12-month poor outcome at 96 hours (AUC 0.76; 95% CI 0.68–0.83) and presepsin at ICU admission (AUC 0.72; 95% CI 0.65–0.78). Elevated procalcitonin concentration at ICU admission predicted unstable haemodynamics in the following 48 hours in a linear regression model. In a multivariate logistic regression model with clinical variables, only procalcitonin at 96 hours had independent prognostic value for poor 12-month neurological outcome.

Conclusions:

Elevated procalcitonin is associated with haemodynamical instability and worsened long-term outcome in OHCA patients. The association is not strong enough for it to be used as a single predictor. Presepsin did not provide clinically relevant information for risk stratification after OHCA.

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