Photo Credit: Jose Luis Calvo Martin & Jose Enrique Garcia-Maurino Muzquiz

The following is a summary of “Plasma glial fibrillary acidic protein and tau: predictors of neurological outcome after cardiac arrest,” published in the April 2024 issue of Critical Care by Arctaedius al.

Researchers conducted a retrospective study to assess glial fibrillary acidic protein (GFAP) and total-tau in plasma as predictors of poor outcome after out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), comparing their effectiveness with neurofilament light (NFL) and neuron-specific enolase (NSE).

They involved patients admitted to an ICU in three hospitals in Sweden (2014 to 2018). Blood samples were obtained upon ICU admission at 12 hours and 48 hours post-cardiac arrest. Poor neurological outcomes were characterized as Cerebral Performance Category 3–5 at 2–6 months following cardiac arrest. Plasma samples underwent retrospective analysis for GFAP, tau, and NFL. Serum NSE was analyzed as part of clinical care. Prognostic performance was assessed using the area under the receiver operating characteristics curve (AUC).

The results showed 428 patients, 328 had OHCA, and 100 had IHCA. GFAP predicted neurological outcome after OHCA with AUC (95% CI) 0.76 (0.70–0.82), 0.86 (0.81–0.90), and 0.91 (0.87–0.96) at ICU admission, 12 h, and 48 h post-cardiac arrest respectively, and after IHCA with AUC (95% CI) 0.77 (0.66–0.87), 0.83 (0.74–0.92), and 0.83 (0.71–0.95). Similarly, tau predicted outcome after OHCA with AUC (95% CI) 0.72 (0.66–0.79), 0.75 (0.69–0.81), and 0.93 (0.89–0.96) at the same time points, and after IHCA with AUC (95% CI) 0.61 (0.49–0.74), 0.68 (0.56–0.79), and 0.77 (0.65–0.90). Adding biomarker level changes between time points did not enhance predictive accuracy compared to the final time point. GFAP at 12 h and 48 h, and tau at 48 h, offered similar predictive value as NSE at 48 h (the earliest time point recommended in guidelines) after OHCA and IHCA in a subset of patients. NFL’s predictive performance was comparable or superior to GFAP and tau at all time points after OHCA and IHCA.

Investigators found GFAP and tau in plasma predicted poor outcomes after cardiac arrest, with GFAP showing potential for use at 12 hours but not surpassing NFL.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04889-0