Our data are in line with the idea of a more extensive approach toward factor inclusion in prognostic models

Our data are in line with the idea of a more extensive approach toward factor inclusion in prognostic models. were documented. In addition, Glasgow coma scale (GCS), blood pressure, and survival status of patients were recorded at 1, 6, 24, and 72 hour(s) after ROSC. Descriptive analyses were performed, and the Cox proportional hazard model was applied to assess if NR2-ab level is an independent predictive factor of survival. Results: 49 successfully resuscitated patients were evaluated; 27 (55%) survived to hospital discharge, 4 (8.1%) were in vegetative state, 10 (20.4%) were physically disabled, and 13 (26.5%) were physically functional. Within 72 hours of ROSC all of the 12 NR2-ab positive patients died. In contrast, 31 (84%) of the NR2-ab negative patients survived. Sensitivity, specificity, positive and negative likelihood ratios of NR2-ab in prediction of survival were 54.5% (95%CI=32.7%-74.9%), 100% (95%CI=84.5%-100%), infinite, and 45.5% (95%CI=28.8%-71.8%), respectively. Subsequent analysis showed that both NR2-ab status and GCS were independent risk factors of death. Conclusions: A positive NR2-ab serum test 1 hour after ROSC correlated with lower 72-hour survival. Further studies are required to validate this finding and demonstrate the value of a quantitative NR2-ab assay and its optimal time of measurement. strong class=”kwd-title” Key Words: NR2, outcome, cardiopulmonary resuscitation, survival Introduction: Neurological recovery is the ultimate goal of successful cardiopulmonary resuscitation (CPR) (1). However, early post-CPR neurological assessment is a clinical challenge (1). Transient cerebral ischemia, sedative medications, and hypothermic resuscitation are common factors that interfere with early post-CPR neurological assessment (2, 3). Furthermore, there are insufficient data to support the reliability of advanced imaging techniques, including computed tomography (CT) and magnetic resonance imaging (MRI), for detection of early ischemic changes, even if they can feasibly be performed in unstable post-CPR patients Tasidotin hydrochloride (2, 4). Recently, serum biomarkers have received growing attention for their ability to indicate neuronal ischemic damage. The greatest number of studies have been performed on S100 and Neuron Specific Enolase (NSE) (5-7), and both have failed to show a consistent correlation with post-CPR outcome in multiple studies. No biomarkers have been shown to be useful in the few hours after cardiopulmonary arrest (5). Furthermore, increase in serum levels of these biomarkers are not specific to brain tissue injuries, making them questionable as ideal biomarkers Tasidotin hydrochloride (6). There is good evidence that the autoantibody toward N-methyl-D-aspartate receptor subunits (NR2) peptide can serve as Tasidotin hydrochloride an early sensitive neurotoxicity biomarker in ischemic stroke patients (8). The NR2 peptide is a subcomponent of the N-methyl-D-aspartate receptor (NMDAR) and is ubiquitously distributed in the central nervous system (9-11). It HSP90AA1 has been shown that NMDAR is cleaved after blood-brain barrier rupture by means of different enzymes, including tissue plasminogen activator (t-PA), resulting in NR2B peptide release and prompting of an ultra-rapid Tasidotin hydrochloride antibody response (12, 13). NR2 antibody (NR2-ab) has been recognised as a neuronal ischemic biomarker. It is useful for differentiation of ischemic strokes from intra-cranial haemorrhages within the first few hours after the event. It also identifies a subgroup of patients with acute transient ischemic attacks (TIA) who are at a higher risk for clinical complications (13, 14). When measured in patients who underwent cardiopulmonary bypass for cardiac surgeries, serum NR2-ab was predictive of neurological complications (15). Additionally, data from animal models have shown increased levels of NR1, NR2A and, especially NR2B fragments in brain tissues after successful CPR has been performed on animals undergoing asphyxic cardiac arrest (16). Based on the above-mentioned points, we primarily raised the question of whether serum NR2-ab could predict poor outcome in successfully resuscitated patients. Methods: em Study design and setting /em This prospective diagnostic test study was conducted in the emergency departments of two teaching hospitals in Tehran, Iran, with the annual census around 45000 and 35000 patients, respectively. As a commitment to follow the under mentioned strict inclusion and exclusion criteria, nonprobability convenience sampling was used to recruit the cases in shifts covered by selected authors Tasidotin hydrochloride who served as attending physicians during November, 2011 to December, 2012. The protocol of this study was approved by Ethical Review Board of Iran University of Medical Sciences. Written consent was received from close family members of all participants. The code of ethics of the World Medical Association (Declaration of Helsinki, as revised in Seoul 2008) was fully read and followed in the present work. em Participants /em Those successfully resuscitated to the point of return of spontaneous circulation (ROSC) were considered eligible for the study, if they maintained that condition for at least one uninterrupted hour. Patients with age 18 years, traumatic or asphyxic arrest, head trauma within the past month, pregnant, or a history of disabling disorders, end stage diseases, loss of blood specimen, central nervous system diseases, persistent severe hypoxemia (O2 saturation 88%) for at least 10 minutes, or required additional CPR attempts within the first hour after ROSC.