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Secretoneurin as a marker for hypoxic brain injury after cardiopulmonary resuscitation

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An Erratum to this article was published on 19 September 2014

Abstract

Purpose

The neuropeptide secretoneurin (SN) shows widespread distribution in the brain. We evaluated whether SN is elevated after cardiopulmonary resuscitation (CPR) and could serve as a potential new biomarker for hypoxic brain injury after CPR.

Methods

This was a prospective observational clinical study. All patients admitted to a tertiary medical intensive care unit after successful CPR with expected survival of at least 24 h were consecutively enrolled from September 2008 to April 2013. Serum SN and neuron-specific enolase were determined in 24 h intervals starting with the day of CPR for 7 days. Neurological outcome was assessed with the Cerebral Performance Categories Scale (CPC) at hospital discharge.

Results

A total of 134 patients were included with 49 % surviving to good neurological outcome (CPC 1–2). SN serum levels peaked within the first 24 h showing on average a sixfold increase above normal. SN levels were significantly higher in patients with poor (CPC 3–5) than in patients with good neurological outcome [0–24 h: 75 (43–111) vs. 38 (23–68) fmol/ml, p < 0.001; 24–48 h: 45 (24–77) vs. 23 (16–39) fmol/ml, p < 0.001]. SN determined within the first 48 h showed a receiver operating characteristic (ROC) area under the curve (AUC) of 0.753 (0.665–0.841). NSE in the first 72 h had a ROC-AUC of 0.881 (0.815–0.946). When combining the two biomarkers an AUC of 0.925 (0.878–0.972) for outcome prediction could be reached.

Conclusions

SN is a promising early biomarker for hypoxic brain injury. Further studies will be required for confirmation of these results.

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Acknowledgments

We thank Marianne Schmid, Markus Theurl, Daniel Marlin and Caroline Linhardt for their support.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria

    Julia Hasslacher, Georg Franz Lehner, Ulrich Harler, Romuald Bellmann, Stefan Dunzendorfer & Michael Joannidis

  2. Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria

    Rudolf Kirchmair

  3. Department of Pharmacology, Medical University Innsbruck, Innsbruck, Austria

    Reiner Fischer-Colbrie

  4. Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

    Ronny Beer

  5. Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria

    Hanno Ulmer

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  1. Julia Hasslacher
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  2. Georg Franz Lehner
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  3. Ulrich Harler
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Correspondence to Michael Joannidis.

Additional information

Take home message: The neuropeptide secretoneurin is a biomarker for hypoxic brain injury which is rapidly released in the first 24 h after cardiopulmonary resuscitation. Owing to its specific kinetics and properties, secretoneurin may significantly improve prediction of neurological outcome in combination with the existing marker neuron-specific enolase. Further studies in the context of SN and CPR are warranted to confirm these results.

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Hasslacher, J., Lehner, G.F., Harler, U. et al. Secretoneurin as a marker for hypoxic brain injury after cardiopulmonary resuscitation. Intensive Care Med 40, 1518–1527 (2014). https://doi.org/10.1007/s00134-014-3423-4

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  • DOI: https://doi.org/10.1007/s00134-014-3423-4

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