Utilization of biomarkers for the prognostic prediction of cardiac arrest survivors using a multi-modal approach

doi:10.5847/wjem.j.1920-8642.2024.029

World Journal of Emergency Medicine ›› 2024, Vol. 15 ›› Issue (2): 131-134.doi: 10.5847/wjem.j.1920-8642.2024.029

• Research Letter • Previous Articles Next Articles

Utilization of biomarkers for the prognostic prediction of cardiac arrest survivors using a multi-modal approach

Changshin Kang¹^,², Yeonho You¹^,², Jung Soo Park¹^,²(), Byeong Kwon Park², Jae Kwang Lee³, Byung Kook Lee⁴

¹Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
²Department of Emergency Medicine, Chungnam National University Hospital, Daejoen 35015, Republic of Korea
³Department of Emergency Medicine, Konyang University Hospital, College of Medicine, Daejeon 35015, Republic of Korea
⁴Department of Emergency Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju 61469, Republic of Korea

Received:2023-09-26 Accepted:2023-01-18 Online:2024-03-11 Published:2024-03-01
Contact: Jung Soo Park, Email: cpcr@cnu.ac.kr

1. supplementary tables 1 and 2.docx(24KB)

Abstract

Changshin Kang, Yeonho You, Jung Soo Park, Byeong Kwon Park, Jae Kwang Lee, Byung Kook Lee. Utilization of biomarkers for the prognostic prediction of cardiac arrest survivors using a multi-modal approach[J]. World Journal of Emergency Medicine, 2024, 15(2): 131-134.

Figures/Tables 3

Figure 1.

Table 1.

Table 2.

Comparison of prognostic performance and sensitivity to poor neurological outcome with a 0% false positive rate after 6 months of return of spontaneous circulation using multi-modal combination predictor

Predictors	AUC (95% CI)	Sensitivity (95% CI)	Specificity (95% CI)	PPV	NPV (95% CI)	P-value^a
Two combinations
(Reference) PLR	0.77 (0.70-0.84)	0.0 (0.0-5.6)	100.0 (94.8-100.0)		51.9	Reference
48/72PNL + PLR	0.92 (0.87-0.98)	59.0 (45.7-71.4)	100.0 (94.8-100.0)	100	73.4 (67.1-78.9)	<0.001
2IN + PLR	0.92 (0.88-0.97)	0.0 (0.0-5.6)	100.0 (94.8-100.0)		51.9 (51.9-51.9)	<0.001
2INFPR0 + PLR	0.86 (0.81-0.92)	50.8 (37.7-63.9)	100.0 (94.8-100.0)	100	69.7 (64.1-74.8)	0.001
3IN + PLR	0.93 (0.89-0.97)	53.1 (40.2-65.7)	100.0 (94.8-100.0)	100	69.7 (63.9-74.9)	<0.001
(Reference) EEG	0.84 (0.78-0.91)	68.8 (53.7-81.3)	100.0 (91.2-100.0)	100	72.7 (63.7-80.2)	Reference
48/72PNL + EEG (n=88)^b	0.91 (0.83-0.98)	74.5 (59.7-86.1)	100.0 (91.2-100.0)	100	76.9 (67.2-84.5)	0.048
2IN + EEG (n=88)^b	0.91 (0.85-0.96)	68.8 (53.7-81.3)	100.0 (91.2-100.0)	100	72.7 (63.7-80.2)	0.01
2INFPR0 + EEG (n=88)^b	0.87 (0.81-0.94)	74.5 (59.7-86.1)	100.0 (91.2-100.0)	100	76.9 (67.2-84.5)	0.08
3IN + EEG, (n=88)^b	0.91 (0.85-0.97)	75.0 (60.4-86.4)	100.0 (91.2-100.0)	100	76.9 (67.1-84.5)	0.01
(Reference) GWR	0.65 (0.55-0.74)	12.5 (5.6-23.2)	100.0 (94.6-100.0)	100	54.5 (52.2-56.8)	Reference
48/72PNL + GWR	0.91 (0.85-0.97)	50.8 (37.7-63.9)	100.0 (94.6-100.0)	100	69.1 (63.4-74.2)	<0.001
2IN + GWR	0.89 (0.83-0.96)	29.7 (18.9-42.4)	100.0 (94.6-100.0)	100	59.8 (55.9-63.6)	<0.001
2INFPR0 + GWR	0.76 (0.68-0.85)	50.8 (37.7-63.9)	100.0 (94.6-100.0)	100	69.1 (63.4-74.2)	<0.001
3IN + GWR	0.90 (0.84-0.96)	59.4 (46.4-71.5)	100.0 (94.6-100.0)	100	72.0 (65.7-77.6)	<0.001
Three combinations
(Reference) PLR + EEG (n=88)^b	0.91 (0.86-0.97)	68.8 (53.7-81.3)	100.0 (91.2-100.0)	100	72.7 (63.7-80.2)	Reference
48/72PNL + PLR + EEG (n=88)^b	0.92 (0.85-0.99)	78.7 (64.3-89.3)	100.0 (91.2-100.0)	100	80.0 (69.8-87.4)	0.74
2IN + PLR + EEG (n=88)^b	0.93 (0.88-0.98)	68.8 (53.7-81.3)	100.0 (91.2-100.0)	100	72.7 (63.7-80.2)	0.26
2INFPR0 + PLR + EEG (n=88)^b	0.92 (0.87-0.98)	74.4 (59.7-86.1)	100.0 (91.2-100.0)	100	76.9 (67.2-84.5)	0.30
3IN + PLR + EEG (n=88)^b	0.93 (0.88-0.98)	75.0 (60.4-86.4)	100.0 (91.2-100.0)	100	76.9 (67.1-84.5)	0.24
(Reference) PLR + GWR	0.83 (0.76-0.90)	45.3 (32.8-58.3)	100.0 (94.6-100.0)	100	65.7 (60.5-70.5)	Reference
48/72PNL + PLR + GWR	0.93 (0.88-0.98)	67.2 (54.0-78.7)	100.0 (94.6-100.0)	100	77.0 (70.0-82.8)	0.048
2IN + PLR + GWR	0.93 (0.88-0.98)	43.8 (31.4-56.7)	100.0 (94.6-100.0)	100	65.0 (60.0-69.8)	0.01
2INFPR0 + PLR + GWR	0.87 (0.81-0.94)	63.9 (50.6-75.8)	100.0 (94.6-100.0)	100	75.3 (68.6-81.0)	0.08
3IN + PLR + GWR	0.93 (0.89-0.98)	64.1 (51.1-75.7)	100.0 (94.6-100.0)	100	74.4 (67.7-80.2)	0.01
(Reference) EEG + GWR (n=88)^b	0.91 (0.85-0.98)	70.8 (55.9-83.0)	100.0 (91.0-100.0)	100	73.6 (64.2-81.2)	Reference
48/72PNL + EEG + GWR (n=88)^b	0.93 (0.87-0.99)	76.6 (62.0-87.7)	100.0 (91.0-100.0)	100	78.0 (67.9-85.6)	0.31
2IN + EEG + GWR (n=88)^b	0.92 (0.86-0.98)	79.2 (65.0-89.5)	100.0 (91.0-100.0)	100	79.6 (69.2-87.1)	0.45
2INFPR0 + EEG + GWR (n=88)^b	0.92 (0.86-0.98)	74.5 (59.7-86.1)	100.0 (91.0-100.0)	100	76.5 (66.6-84.1)	0.30
3IN + EEG + GWR (n=88)^b	0.92 (0.86-0.98)	81.3 (67.4-91.1)	100.0 (91.0-100.0)	100	81.2 (70.6-88.6)	0.43
Four combinations
(Reference) PLR + EEG + GWR (n=88)^b	0.94 (0.90-0.99)	81.3 (67.4-91.1)	100.0 (91.0-100.0)	100	81.2 (70.6-88.6)	Reference
48/72PNL + PLR + EEG + GWR (n=88)^b	0.95 (0.90-0.995)	83.0 (69.2-92.4)	100.0 (91.0-100.0)	100	83.0 (72.2-90.2)	0.61
2IN + PLR + EEG + GWR (n=88)^b	0.95 (0.90-0.99)	79.2 (65.0-89.5)	100.0 (91.0-100.0)	100	79.6 (69.2-87.1)	0.54
2INFPR0 + PLR + EEG + GWR (n=88)^b	0.94 (0.90-0.99)	83.0 (69.2-92.4)	100.0 (91.0-100.0)	100	83.0 (72.2-90.2)	0.82
3IN + PLR + EEG + GWR (n=88)^b	0.95 (0.90-0.99)	83.3 (69.8-92.5)	100.0 (91.0-100.0)	100	83.0 (72.2-90.2)	0.41

Table 2.

References 7

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2	Stammet P, Collignon O, Hassager C, Wise MP, Hovdenes J, Åneman A, et al. Neuron-specific enolase as a predictor of death or poor neurological outcome after out-of-hospital cardiac arrest and targeted temperature management at 33 °C and 36 °C. J Am Coll Cardiol. 2015; 65(19):2104-14. doi: 10.1016/j.jacc.2015.03.538 pmid: 25975474
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Serum NSE levelsL	AUC (95% CI)	Cut-off, μg/L	Sensitivity (95% CI)	Specificity (95% CI)	PPV (95% CI)	NPV (95% CI)	P-value
Immediately after ROSC	0.81 (0.73-0.88)	>54.8	32.8 (21.6-45.7)	100.0 (94.8-100.0)	100.0	61.6 (57.5-65.6)	<0.001
Immediately after ROSC	0.81 (0.73-0.88)	>44.5^a	43.8 (31.4-56.7)	95.7 (87.8-99.1)	90.3 (74.9-96.7)	64.7 (59.5-69.6)	<0.001
24 h after ROSC	0.86 (0.79-0.93)	>85.3	46.0 (33.4-59.1)	100.0 (94.6-100.0)	100.0	66.3 (61.1-71.2)	<0.001
24 h after ROSC	0.86 (0.79-0.93)	>53.0^a	58.7 (45.6-71.0)	95.5 (87.5-99.1)	92.5 (80.0-97.4)	71.1 (64.6-76.9)	<0.001
48 h after ROSC	0.91 (0.84-0.97)	>64.2	67.2 (54.0-78.7)	100.0 (94.7-100.0)	100.0	77.3 (70.4-83.0)	<0.001
48 h after ROSC	0.91 (0.84-0.97)	>39.7^a	80.3 (68.2-89.4)	95.6 (87.6-99.1)	94.2 (84.3-98.0)	84.4 (76.5-90.0)	<0.001
72 h after ROSC	0.90 (0.84-0.96)	>144	48.3 (35.0-61.8)	100.0 (94.6-100.0)	100.0	69.1 (63.5-74.1)	<0.001
72 h after ROSC	0.90 (0.84-0.96)	>57.0^a	77.6 (64.7-87.5)	95.5 (87.5-99.1)	93.7 (83.1-97.9)	83.1 (75.3-88.9)	<0.001
48/72PNL^b	0.91 (0.85-0.97)	>144	50.8 (37.7-63.9)	100.0 (94.8-100.0)	100.0	69.7 (64.1-74.8)	<0.001
48/72PNL^b	0.91 (0.85-0.97)	>57.0^a	82.0 (70.0-90.6)	95.7 (87.8-99.1)	94.3 (84.6-98.1)	85.7 (77.8-91.1)	<0.001
2IN ^c	0.89 (0.84-0.95)	NA	0.0 (0.0-5.6)	100.0 (94.8-100.0)	NA	51.9	<0.001
2IN ^c	0.89 (0.84-0.95)	>60^a	82.8 (71.3-91.1)	95.7 (87.8-99.1)	94.6 (85.3-98.2)	85.7 (77.8-91.1)	<0.001
2INFPR0 ^d	0.75 (0.69-0.82)	>144	50.8 (37.7-63.9)	100.0 (94.8-100.0)	100.0	69.7 (64.1-74.8)	<0.001
2INFPR0 ^d	0.75 (0.69-0.82)	>144^a	50.8 (37.7-63.9)	100.0 (94.8-100.0)	100.0	69.7 (64.1-74.8)	<0.001
3IN ^e	0.90 (0.86-0.95)	>144	53.1 (40.2-65.7)	100.0 (94.8-100.0)	100.0	69.7 (63.9-74.9)	<0.001
3IN ^e	0.90 (0.86-0.95)	>60^a	82.8 (71.3-91.1)	95.7 (87.8-99.1)	94.6 (85.3-98.2)	85.7 (77.8-91.1)	<0.001

Utilization of biomarkers for the prognostic prediction of cardiac arrest survivors using a multi-modal approach

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