Proteomic Profiling to Reveal Novel Prognostic Markers for Neurological Outcome Following Resuscitation

NCT ID: NCT01960699

Last Updated: 2020-02-24

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 96 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2013-10-31
• Study Completion Date: 2020-01-31

Brief Summary

Background: Cardiac arrest is a life-threatening event. Intensivists are challenged with an increasing number of patients with uncertain neurological outcome following cardiopulmonary resuscitation (CPR). The prognostic value of current biomarkers for neurophysiologic long-term outcome is limited.

Hypothesis: We hypothesize that specific brain-derived tissue leakage proteins can be identified to reveal novel, more reliable prognostic biomarkers for good neurological outcome.

Methods: This translational study (n=100) is a combination of a prospective basic science study intended to reduce the number of potential plasma biomarker candidates by proteomic shotgun analyses in brain tissue autopsy samples and plasma samples from resuscitated patients (n=10) and a prospective clinical validation study in a large study population (n=90) by high-throughput analyses. Selection of proteomic markers and signature estimation will be performed to discriminate patients with good and poor outcome.

Clinical perspective: A structured proteomic analysis approach might identify the best marker out of all proteins liberated during cellular damage.

Detailed Description

Background: Cardiac arrest is a life-threatening event. Intensivists are challenged with an increasing number of patients with uncertain neurological outcome following cardiopulmonary resuscitation (CPR). The prognostic value of current biomarkers for neurophysiologic long-term outcome is limited. Therefore, identification of novel plasma markers with higher predictive value for neurophysiological recovery is critical for patient management after CPR.

Hypothesis: We hypothesize that specific brain-derived tissue leakage proteins can be identified to reveal novel, more reliable prognostic biomarkers for good neurological outcome.

Methods: This translational study (n=100) is a combination of a prospective basic science study intended to reduce the number of potential plasma biomarker candidates by proteomic shotgun analyses in brain tissue autopsy samples and plasma samples from resuscitated patients (n=10) and a prospective clinical validation study in a large study population (n=90) by high-throughput analyses. Samples will be analyzed by proteomic shotgun analyses using the Q-Exactive quadrupole-orbitrap mass spectrometer (MS). MS/MS data will be interpreted by the MaxQuant and Perseus Software. In order to identify brain-derived proteins within plasma, the plasma proteome of 10 resuscitated patients will be compared to the proteomic profile of brain tissue. This will reduce the number of potential plasma biomarker candidates associated with neurologic outcome. The prospective validation in plasma samples will be performed by a targeted proteomics approach using selected reaction monitoring (SRM) on a triple quadrupole ion MS. Neurological outcome will be assessed by the five-point scale (death, persistent vegetative state, severe disability, moderate disability, and good recovery) according to the cerebral performance categories (CPC). A CPC sore of <3 is considered a good neurological outcome. Selection of proteomic markers and signature estimation will be performed by L1 regularized logistic regression, where the tuning parameter will be optimized by cross-validated model performance. The signature's ability to discriminate patients with good and poor outcome will be described by ROC analysis.

Clinical perspective: An accurate predictor of neurological outcome following CPR is of utmost clinical importance. However, previous studies focused on a very limited array of biomarkers. Therefore, a structured proteomic analysis approach might identify the best marker out of all proteins liberated during cellular damage.

Conditions

Cardiac Arrest With Successful Resuscitation

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

CPC < 3

Good neurological outcome

No interventions assigned to this group

CPC >/= 3

Unvavourable neurologic outcome

No interventions assigned to this group

Eligibility Criteria

Inclusion Criteria

1. Nontraumatic, normothermic cardiac arrest due to cardiac disorders, respiratory failures, or hemodynamic or metabolic factors.

2. A Glasgow Coma Scale of 3, none of the patients will be conscious at the time of hospital admission.

3. No previous cardiac arrest, as well as known or coexisting neurological disorders or neoplasms of the central nervous system.

4. No history of psychiatric illness, no alcohol or drug dependency, and no psychotropic medication.

5. Initiation of mild therapeutic hypothermia

Exclusion Criteria

1. hydrocephalus and shunt artifact

2. severe movement artifacts

3. intracerebral hemorrhage

4. old large ischemic lesion

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 99 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Medical University of Vienna

OTHER

Sponsor Role: lead

Responsible Party

Christopher Adlbrecht

PI

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Christopher Adlbrecht, MD

Role: PRINCIPAL_INVESTIGATOR

Medical University of Vienna

Locations

Medical University of Vienna

Vienna, , Austria

Countries

Austria

References

Distelmaier K, Muqaku B, Wurm R, Arfsten H, Seidel S, Kovacs GG, Mayer RL, Szekeres T, Wallisch C, Hubner P, Goliasch G, Heinze G, Heinz G, Sterz F, Gerner C, Adlbrecht C. Proteomics-Enriched Prediction Model for Poor Neurologic Outcome in Cardiac Arrest Survivors. Crit Care Med. 2020 Feb;48(2):167-175. doi: 10.1097/CCM.0000000000004105.

Reference Type: RESULT

PMID: 31939784 (View on PubMed)

Other Identifiers

EK_Nr_1740/2013

Identifier Type: -

Identifier Source: org_study_id