Soluble urokinase plasminogen activator receptor (suPAR): Its relation to neurological outcome in patients with survived cardiac arrest

Background: High serum levels of the inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) have been associated with poor neurological outcome in patients after cardiac arrest (CA), but with inadequate and contradictive prediction values. The purpose of this study was to provide further evidence on the prognostic value of suPAR for the prediction of poor neurological outcome after initially survived CA. Methods: A total of 177 patients were prospectively enrolled in this cohort study. 85 patients with survived CA were included and the neurological outcome was assessed after 6 months. 71 patients with ST-segmental elevation myocardial infarction (STEMI) and 21 healthy control patients served as comparative groups. Results: The serum suPAR levels on admission and the subsequent serum course were significantly higher in patients with CA as compared to STEMI and control patients. Furthermore, patients with poor neurological outcome showed significantly higher serum suPAR levels as compared to patients with good neurological outcome. By the use of ROC-curves and setting the specificities to 100%, inadequate sensitivities and cut-off values were calculated (day 2: sensitivity 21.1%, cut-off 10.2 ng/dl, AUC 0.716). By setting the specificities to at least 80% the best prediction values could be calculated for day 2 with a sensitivity of 57.9% and a cut-off value of 5.3 ng/dl. Conclusions: SuPAR serum levels in patients with poor neurological outcome were significantly higher as compared to patients with good neurological outcome. However, the prognostic value was low and inadequate because of a substantial overlap of serum suPAR levels between the outcome groups

Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation

International audienceBackground: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality. Methods: Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score–matched cohort. Results: Left ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63–0.98]; P =0.03) without differences in various subgroups. Complications occurred more frequently in patients with left ventricular unloading: severe bleeding in 98 (38.4%) versus 45 (17.9%), access site–related ischemia in 55 (21.6%) versus 31 (12.3%), abdominal compartment in 23 (9.4%) versus 9 (3.7%), and renal replacement therapy in 148 (58.5%) versus 99 (39.1%). Conclusions: In this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial