scholarly journals Serum neprilysin and the risk of death in patients with out-of-hospital cardiac arrest of non-traumatic origin

2018 ◽  
Vol 9 (4_suppl) ◽  
pp. S169-S174 ◽  
Author(s):  
Thomas A Zelniker ◽  
Sebastian Spaich ◽  
Jan Stiepak ◽  
Florian Steger ◽  
Hugo A Katus ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Troponin T ◽  
High Sensitivity ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
High Sensitivity Troponin ◽  
All Cause Mortality ◽  
Traumatic Origin ◽  
High Sensitivity Troponin T ◽  
Hospital Cardiac Arrest

Background: Early risk stratification remains an unmet clinical need in patients with in out-of-hospital cardiac arrest. We hypothesised that soluble neprilysin may represent a promising biomarker in patients with out-of-hospital cardiac arrest of non-traumatic origin and provide new pathobiological insight. Methods: This pilot study was a biomarker analysis from the Heidelberg Resuscitation Registry. Serum soluble neprilysin levels on admission were measured in 144 patients with successful return of spontaneous circulation after out-of-hospital cardiac arrest of non-traumatic origin. The primary endpoint was time to all-cause mortality. KM Event Rates are reported. Cox models were adjusted for age, bystander resuscitation, initial ECG rhythm, baseline estimated glomerular filtration rate, baseline lactate, left ventricular function at baseline, and targeted temperature management. Results: In total, 90 (62.5%) patients died over a follow-up of at least 30 days. Soluble neprilysin correlated weakly with high-sensitivity troponin T ( r=0.18, P=0.032) but did not correlate significantly with estimated glomerular filtration rate ( r=−0.12) or lactate ( r=0.11). Patients with elevated soluble neprilysin levels on admission were at significantly higher risk of all-cause mortality (Q4 69.1% vs. Q1 48.4%). After multivariable adjustment, soluble neprilysin in the top quartile (Q4) was significantly associated with all-cause mortality (Q4 vs. Q1: adjusted hazard ratio 2.48 (1.20–5.12)). In an adjusted multimarker model including high-sensitivity troponin T and high-sensitivity C-reactive protein, soluble neprilysin and high-sensitivity troponin T remained independently associated with all-cause mortality (soluble neprilysin: adjusted hazard ratio 2.27 (1.08–4.78); high-sensitivity troponin T: adjusted hazard ratio 3.40 (1.63–7.09)). Conclusion: Soluble neprilysin, measured as early as on hospital admission, was independently associated with all-cause mortality in patients with out-of-hospital cardiac arrest of non-traumatic origin and may prove to be useful in the estimation of risk in these patients.

Abstract 26: Prevalence and Pattern of Myocardial Injury in Patients With Cardiac vs Non-Cardiac Cause of Out-Of-Hospital Cardiac Arrest: A One-Year Multicenter Clinical Experience With the High-Sensitivity Troponin T Assay

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
David E Hamilton ◽  
Bradley J Petek ◽  
Lindsay G Panah ◽  
Sean R Mendez ◽  
Philip E Dormish ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Myocardial Injury ◽  
Troponin T ◽  
Clinical Care ◽  
High Sensitivity ◽  
Severity Of Injury ◽  
High Sensitivity Troponin T ◽  
One Year ◽  
Hospital Cardiac Arrest

Introduction: Myocardial injury is common after out-of-hospital-cardiac arrest (OHCA). However, little is known about the role of early serial hs-TnT in patients with OHCA for identifying myocardial injury, and whether the prevalence and severity of injury differs according to cardiac (CV) vs noncardiac (non-CV) cause of OHCA. Hypothesis: Early hs-TnT will demonstrate high rates of myocardial injury after OHCA regardless of etiology. However, in the first 6 hours after OHCA the extent of hs-TnT elevation and rate of rise will be higher in patients with CV vs non-CV etiology. Methods: Multicenter retrospective study including OHCA patients presenting from 4/1/2018 to 4/1/2019. Hs-TnT was drawn as part of routine clinical care. Results: Baseline hs-TnT was measured in 120 patients after OHCA due to CV (n=51) and non-CV (n=69) etiologies, with subsequent serial hs-TnT values at 1hr, 3hrs, and 6hrs. Hs-TnT was greater than the 99 th percentile in 97% (115/120) of patients and myocardial injury (hs-TnT> 52ng/L) was detected in 88% (105/120) of patients (no difference between CV vs non-CV etiology). Median hs-TnT values were compared between CV and non-CV etiologies of OHCA identifying no difference in hs-TnT at baseline (Figure: 54 [IQR 18-134] vs. 41 [IQR 19-100]; p=0.357) but significantly higher hs-TnT in patients with CV etiology at 1hr (159 [IQR 80-392] vs 93 [IQR 42-247]; p=0.049), 3hrs (400 [IQR 168-1005] vs 151 [IQR 75-401] p=0.009), and 6hrs (746 [IQR 248-1965] vs 251 [IQR 75-580]; p=0.001). Additionally, hs-TnT rise from baseline was present in both CV and non-CV etiologies but was significantly higher in patients with CV etiology (p = 0.005). Conclusions: As identified by hs-TnT, myocardial injury was prevalent in patients with both CV and non-CV cause of OHCA. Baseline hs-TnT was no different in patients with CV vs non-CV cause, however, over the first 6 hours both absolute value and rate of hs-TnT rise were significantly higher for patients with CV vs non-CV etiology of OHCA.

Increased serum level of high sensitivity troponin T even prior to surgery can predict adverse events during carotid endarterectomy

Vascular ◽  
2021 ◽  
pp. 170853812098629
Author(s):  
Bálint Nagy ◽  
Elettra Engblom ◽  
Marijana Matas ◽  
Péter Maróti ◽  
Tamás Kőszegi ◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Matrix Metalloproteinase ◽  
Carotid Endarterectomy ◽  
Troponin T ◽  
High Sensitivity ◽  
Matrix Metalloproteinase 9 ◽  
Tissue Inhibitor Of Metalloproteinase ◽  
High Sensitivity Troponin ◽  
High Sensitivity Troponin T ◽  
Metalloproteinase 9

Objectives Perioperative stress affects the outcome of carotid endarterectomy performed under regional anesthesia. Here we aimed to explore the temporal profile of the stress marker cortisol and its relationship to high-sensitivity troponin-T, matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, and S100B as an indicator of blood–brain barrier alteration in the systemic circulation. Methods Prospective part of the study: a total of 31 patients with significant carotid stenosis scheduled for carotid endarterectomy in regional anesthesia were enrolled. Follow-up part of the study and retrospective analysis of the outcome: each patient was followed up to five years and morbidity as well as mortality data were collected from an electronic database. Blood samples from each patient were serially taken; prior to surgery (T1), at the time of reperfusion (T2), 24 h (T3) and 72 h later postoperatively (T4), then the plasma concentration of each biomarker was measured. Besides, the clinical and surgical factors and perioperative adverse events were recorded. Results More positive correlations were found between: the early change of S100B (T2–T1) and late change in plasma cortisol level (T4–T3) (r = 0.403; p < 0.05); the early change of cortisol (T2–T1) and the early postoperative change of plasma matrix metalloproteinase-9 level (T3–T2) (r = 0.432; p = 0.01); the plasma concentration of tissue inhibitor of metalloproteinase-1 at 24 postoperative hours and the late change in plasma high-sensitivity troponin-T level (T4–T3) (r = 0.705; p < 0.001). Five patients needed an intraoperative shunt in whom the high-sensitivity troponin-T was elevated even prior to surgery, but definitive stroke never occurred. Plasma matrix metalloproteinase-9 concentration at reperfusion independently predicted the five-year mortality with a cut-off value of 456 ng/ml (sensitivity: 86%, specificity: 84%, area 0.887, p = 0.002). Conclusions A higher intraoperative change in S100B level reflecting carotid endarterectomy induced acute silent brain ischemia was associated with more pronounced post-operative change of cortisol. An early elevation of cortisol was found to be associated with a delayed increase of matrix metalloproteinase-9. Importantly, an increased high-sensitivity troponin-T even prior to carotid endarterectomy may predict clamp intolerance, and elevated matrix metalloproteinase-9 at reperfusion suggests a poor outcome.

Diagnosis performance of high sensitivity troponin assay in out-of-hospital cardiac arrest patients

2013 ◽  
Vol 169 (6) ◽  
pp. 449-454 ◽  
Author(s):  
Guillaume Geri ◽  
Nicolas Mongardon ◽  
Florence Dumas ◽  
Camille Chenevier-Gobeaux ◽  
Olivier Varenne ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Sensitivity ◽  
High Sensitivity Troponin ◽  
Hospital Cardiac Arrest

scholarly journals Age-adjusted high-sensitivity troponin T cut-off value for risk stratification of pulmonary embolism

2015 ◽  
Vol 45 (5) ◽  
pp. 1323-1331 ◽  
Author(s):  
Anja Kaeberich ◽  
Valerie Seeber ◽  
David Jiménez ◽  
Maciej Kostrubiec ◽  
Claudia Dellas ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Adverse Outcome ◽  
Troponin T ◽  
High Sensitivity ◽  
Severity Index ◽  
Characteristic Analysis ◽  
Prognostic Information ◽  
High Sensitivity Troponin ◽  
Advanced Therapy ◽  
High Sensitivity Troponin T

High-sensitivity troponin T (hsTnT) helps in identifying pulmonary embolism patients at low risk of an adverse outcome. In 682 normotensive pulmonary embolism patients we investigate whether an optimised hsTnT cut-off value and adjustment for age improve the identification of patients at elevated risk.Overall, 25 (3.7%) patients had an adverse 30-day outcome. The established hsTnT cut-off value of 14 pg·mL−1 retained its high prognostic value (OR (95% CI) 16.64 (2.24–123.74); p=0.006) compared with the cut-off value of 33 pg·mL−1 calculated by receiver operating characteristic analysis (7.14 (2.64–19.26); p<0.001). In elderly (aged ≥75 years) patients, an age-optimised hsTnT cut-off value of 45 pg·mL−1 but not the established cut-off value of 14 pg·mL−1 predicted an adverse outcome. An age-adjusted hsTnT cut-off value (≥14 pg·mL−1 for patients aged <75 years and ≥45 pg·mL−1 for patients aged ≥75 years) provided additive and independent prognostic information on top of the simplified pulmonary embolism severity index (sPESI) and echocardiography (OR 4.56 (1.30–16.01); p=0.018, C-index=0.77). A three-step approach based on the sPESI, hsTnT and echocardiography identified 16.6% of all patients as being at higher risk (12.4% adverse outcome).Risk assessment of normotensive pulmonary embolism patients was improved by the introduction of an age-adjusted hsTnT cut-off value. A three-step approach helped identify patients at higher risk of an adverse outcome who might benefit from advanced therapy.

Sign in / Sign up

Export Citation Format

Share Document