The value of cerebrospinal fluid ubiquitin C-terminal hydrolase-L1 protein as a prognostic predictor of neurologic outcome in post-cardiac arrest patients treated with targeted temperature management

Abstract

Aim: We evaluated the prognostic value of serum- and cerebrospinal fluid (CSF)-ubiquitin carboxyl-terminal esterase L1 protein (UCHL1) measurements in post- post-out of hospital cardiac arrest (OHCA) patients treated with target temperature management (TTM), to predict neurologic outcome.

Methods: This was a prospective single-centre observational cohort study, conducted from April 2018 to September 2019. Serum- and CSF-UCHL1 were obtained immediately (UCHL1_initial), 24 h (UCHL1₂₄), 48 h (UCHL1₄₈), and 72 h (UCHL1₇₂) after return of spontaneous circulation (ROSC). The area under the receiver operating characteristic curves (AUROC) and Delong method were used to identify cut-off values of serum- and CSF-UCHL1_initial, UCHL1₂₄, UCHL1₄₈, UCHL1₇₂ for predicting neurologic outcomes.

Results: Of 38 patients enrolled, 16 comprised the poor outcome group. The AUROCs for serum- and CSF-UCHL1_initial were 0.71 and 0.93 in predicting poor neurological outcomes, respectively (p = 0.01). The AUROCs for serum- and CSF-UCHL1₂₄ were 0.85 and 0.91 (p = 0.24). The AUROCs for serum- and CSF-UCHL1₄₈ were 0.90 and 0.97 (p = 0.07). The AUROCs for serum- and CSF-UCHL1₇₂ were 0.94 and 0.98 (p = 0.25).

Conclusion: Findings of this study demonstrate that CSF-UCHL1 measured immediately, 24, 48, and 72 h after ROSC is a valuable predictor for evaluating neurologic outcomes, whereas serum-UCHL1 measured at 24, 48, and 72 h after ROSC showed a significant performance in the prognostication of poor outcomes in post-OHCA patients treated with TTM.

Keywords: Cardiac arrest; Prognostication; UCHL1 protein.