• Logo
  • SBMUJournals

The Value of Serum NR2 Antibody in Prediction of Post-Cardiopulmonary Resuscitation Survival

Ali Bidari, Samira Vaziri, Ehsan Moazen Zadeh, Sahar Farahmand, Elham Talachian
227

Views


Abstract

Introduction: N-methyl-D-aspartate receptor subunits antibody (NR2-ab) is a sensitive marker of ischemic brain damage in clinical circumstances, such as cerebrovascular accidents. We aimed to assess the value of serum NR2-ab in predicting the post-cardiopulmonary resuscitation (CPR) survival. Methods: In this cohort study, we examined serum NR2-ab levels 1 hour after the return of spontaneous circulation (ROSC) in 49 successfully resuscitated patients. Patients with traumatic or asphyxic arrests, prior neurological insults, or major medical illnesses were excluded. Participants were followed until death or hospital discharge. Demographic data, coronary artery disease risk factors, time before initiation of CPR, and CPR duration 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.

Keywords

NR2; outcome; cardiopulmonary resuscitation; survival

References

Becker LB, Aufderheide TP, Geocadin RG, et al. Primary outcomes for resuscitation science studies a consensus statement from the American Heart Association. Circulation. 2011;124(19):2158-77.

Wijdicks EF, Hijdra A, Young G, Bassetti C, Wiebe S. Practice Parameter: Prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review) Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;67(2):203-10.

Oddo M, Rossetti AO. Predicting neurological outcome after cardiac arrest. Curr Opin Crit Care. 2011;17(3):254-9.

Friberg H, Rundgren M, Westhall E, Nielsen N, Cronberg T. Continuous evaluation of neurological prognosis after cardiac arrest. Acta Anaesthesiol Scand. 2013;57(1):6-15.

Shinozaki K, Oda S, Sadahiro T, et al. S-100B and neuron-specific enolase as predictors of neurological outcome in patients after cardiac arrest and return of spontaneous circulation: a systematic review. Critical Care. 2009;13(4):R121.

Seco M, Edelman JJB, Wilson MK, Bannon PG, Vallely MP. Serum biomarkers of neurologic injury in cardiac operations. Ann Thorac Surg. 2012;94(3):1026-33.

Ekmektzoglou KA, Xanthos T, Papadimitriou L. Biochemical markers (NSE, S-100, IL-8) as predictors of neurological outcome in patients after cardiac arrest and return of spontaneous circulation. Resuscitation. 2007;75(2):219-28.

Dambinova SA, Khounteev GA, Skoromets AA. Multiple panel of biomarkers for TIA/stroke evaluation. Stroke. 2002;33(5):1181-2.

Cull-Candy S, Brickley S, Farrant M. NMDA receptor subunits: diversity, development and disease. Curr Opin Neurobiol. 2001;11(3):327-35.

Köhr G. NMDA receptor function: subunit composition versus spatial distribution. Cell Tissue Res. 2006;326(2):439-46.

Hosseini M, Karami Z, Janzadenh A, et al. The effect of intrathecal administration of muscimol on modulation of neuropathic pain symptoms resulting from spinal cord injury; an experimental study. Emergency. 2014;2(4):151-7.

Ng K-S, Leung H-W, Wong PT-H, Low C-M. Cleavage of the nr2b subunit amino terminus of n-methyl-d-aspartate (NMDA) receptor by tissue plasminogen activator identification of the cleavage site and characterization of ifenprodil and glycine affinities on truncated nmda receptor. J Biol Chem. 2012;287(30):25520-9.

Dambinova SA, Khounteev GA, Izykenova GA, Zavolokov IG, Ilyukhina AY, Skoromets AA. Blood test detecting autoantibodies to N-methyl-D-aspartate neuroreceptors for evaluation of patients with transient ischemic attack and stroke. Clin Chem. 2003;49(10):1752-62.

Kasmaei HD, Baratloo A, Nasiri Z, Soleymani M, Yazdani MO. Recombinant Tissue Plasminogen Activator Administration in Patients With Cerebrovascular Accident; A Case Series. Arch Neurosci. 2015;2(2):e23315

Bokesch PM, Izykenova GA, Justice JB, Easley KA, Dambinova SA. NMDA receptor antibodies predict adverse neurological outcome after cardiac surgery in high-risk patients. Stroke. 2006;37(6):1432-6.

Guerguerian A-M, Brambrink AM, Traystman RJ, Huganir RL, Martin LJ. Altered expression and phosphorylation of N-methyl-D-aspartate receptors in piglet striatum after hypoxia–ischemia. Mol Brain rES. 2002;104(1):66-80.

Weissman JD, Khunteev GA, Heath R, Dambinova SA. NR2 antibodies: risk assessment of transient ischemic attack (TIA)/stroke in patients with history of isolated and multiple cerebrovascular events. J Neurol Sci. 2011;300(1):97-102.

Pfeifer R, Börner A, Krack A, Sigusch HH, Surber R, Figulla HR. Outcome after cardiac arrest: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale. Resuscitation. 2005;65(1):49-55.

Kamps M, Horn J, Oddo M, et al. Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature. Intensive Care Med. 2013;39(10):1671-82.

Püttgen HA, Geocadin R. Predicting neurological outcome following cardiac arrest. J Neurol Sci. 2007;261(1):108-17.

Panteghini M, Pagani F, Bonetti G. The sensitivity of cardiac markers: an evidence-based approach. Clin Chem Lab Med. 1999;37(11-12):1097-106.




DOI: https://doi.org/10.22037/emergency.v3i3.9250

Refbacks

  • There are currently no refbacks.