CT ‐pro AVP (copeptin), MR ‐pro ANP and Peroxiredoxin 4 after cardiac arrest: release profiles and correlation to outcome

Background Further characterization of the post‐cardiac arrest syndrome ( PCAS ) is essential to better understand the mechanisms resulting in injury and death. We investigated serial serum concentrations of the stress hormone c‐terminal provasopressin ( CT ‐pro AVP or copeptin), the cardiac biomarker MR ‐pro ANP and a biomarker of oxidation injury, Peroxiredoxin 4 ( Prx 4) in patients treated with mild hypothermia ( MHT ) after cardiac arrest, and studied their association to the PCAS and long‐term outcome. Methods Serum samples from cardiac arrest patients were collected serially: at admission, 2, 6, 12, 24, 36, 48 and 72 h after cardiac arrest. CT ‐pro AVP , MR ‐pro ANP and Prx 4 concentrations were determined and tested for association with two surrogate markers of PCAS (time to return of spontaneous circulation and circulation‐ SOFA score) and with cerebral performance category ( CPC ) at 6 months. Good outcome was defined as CPC 1 to 2. Results Eighty‐four patients were included. CT ‐pro AVP , MR ‐pro ANP and Prx 4 were early biomarkers with maximum concentrations soon after cardiac arrest and with a significant discriminatory ability between good and poor long‐term outcome at most time points. CT ‐pro AVP predicted a poor outcome with the highest accuracy, followed by MR ‐pro ANP and Prx 4 (area under the receiving operating characteristics curve at 12 h of 0.85, 0.77 and 0.76 respectively). CT ‐pro AVP and MR ‐pro ANP showed best correlation to the PCAS . Conclusion I n 84 resuscitated patients receiving MHT after cardiac arrest, there is a significant difference in concentrations of CT ‐pro AVP , MR ‐pro ANP and Prx 4 between patients with good and poor outcome. CT ‐pro AVP and MR ‐pro ANP have a significant correlation to surrogate markers of the PCAS .