Low PCSK-9 levels Are Associated with Favorable Neurologic Function after Resuscitation from out of Hospital Cardiac Arrest
Endotoxemia after cardiopulmonary resuscitation (CPR) is associated with unfavorable outcome. Proprotein convertase subtilisin/kexin type-9 (PCSK–9) regulates low-density lipoprotein receptors, which mediate the hepatic uptake of endotoxins. We hypothesized that PCSK–9 concentrations are associated...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/8/2606 |
| _version_ | 1797558852121526272 |
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| author | Anne Merrelaar Nina Buchtele Christoph Schriefl Christian Clodi Michael Poppe Florian Ettl Harald Herkner Bernd Jilma Michael Schwameis Christian Schoergenhofer |
| author_facet | Anne Merrelaar Nina Buchtele Christoph Schriefl Christian Clodi Michael Poppe Florian Ettl Harald Herkner Bernd Jilma Michael Schwameis Christian Schoergenhofer |
| author_sort | Anne Merrelaar |
| collection | DOAJ |
| description | Endotoxemia after cardiopulmonary resuscitation (CPR) is associated with unfavorable outcome. Proprotein convertase subtilisin/kexin type-9 (PCSK–9) regulates low-density lipoprotein receptors, which mediate the hepatic uptake of endotoxins. We hypothesized that PCSK–9 concentrations are associated with neurological outcome in patients after CPR. Successfully resuscitated out-of-hospital cardiac arrest patients were included prospectively (<i>n</i> = 79). PCSK–9 levels were measured on admission, 12 h and 24 h thereafter, and after rewarming. The primary outcome was favorable neurologic function at day 30, defined by cerebral performance categories (CPC 1–2 = favorable vs. CPC 3–5 = unfavorable). Receiver operating characteristic curve analysis was used to identify the PCSK–9 level cut-off for optimal discrimination between favorable and unfavorable 30-day neurologic function. Logistic regression models were calculated to estimate the effect of PCSK–9 levels on the primary outcome, given as odds ratio (OR) and 95% confidence interval (95%CI). PCSK–9 levels on admission were significantly lower in patients with favorable 30-day neurologic function (median 158 ng/mL, (quartiles: 124–225) vs. 207 ng/mL (174–259); <i>p</i> = 0.019). The optimally discriminating PCSK–9 level cut-off was 165 ng/mL. In patients with PCSK–9 levels ≥ 165 ng/mL, the odds of unfavorable neurological outcome were 4.7-fold higher compared to those with PCSK–9 levels < 165 ng/mL. In conclusion, low PCSK–9 levels were associated with favorable neurologic function. |
| first_indexed | 2024-03-10T17:37:13Z |
| format | Article |
| id | doaj.art-247d1ea648e1407a80e524a280791c8b |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T17:37:13Z |
| publishDate | 2020-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-247d1ea648e1407a80e524a280791c8b2023-11-20T09:48:09ZengMDPI AGJournal of Clinical Medicine2077-03832020-08-0198260610.3390/jcm9082606Low PCSK-9 levels Are Associated with Favorable Neurologic Function after Resuscitation from out of Hospital Cardiac ArrestAnne Merrelaar0Nina Buchtele1Christoph Schriefl2Christian Clodi3Michael Poppe4Florian Ettl5Harald Herkner6Bernd Jilma7Michael Schwameis8Christian Schoergenhofer9Department of Emergency Medicine, Medical University of Vienna and Austria, 1090 Vienna, AustriaDepartment of Internal Medicine I, Medical University of Vienna and Austria, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna and Austria, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna and Austria, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna and Austria, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna and Austria, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna and Austria, 1090 Vienna, AustriaDepartment of Clinical Pharmacology, Medical University of Vienna and Austria, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna and Austria, 1090 Vienna, AustriaDepartment of Clinical Pharmacology, Medical University of Vienna and Austria, 1090 Vienna, AustriaEndotoxemia after cardiopulmonary resuscitation (CPR) is associated with unfavorable outcome. Proprotein convertase subtilisin/kexin type-9 (PCSK–9) regulates low-density lipoprotein receptors, which mediate the hepatic uptake of endotoxins. We hypothesized that PCSK–9 concentrations are associated with neurological outcome in patients after CPR. Successfully resuscitated out-of-hospital cardiac arrest patients were included prospectively (<i>n</i> = 79). PCSK–9 levels were measured on admission, 12 h and 24 h thereafter, and after rewarming. The primary outcome was favorable neurologic function at day 30, defined by cerebral performance categories (CPC 1–2 = favorable vs. CPC 3–5 = unfavorable). Receiver operating characteristic curve analysis was used to identify the PCSK–9 level cut-off for optimal discrimination between favorable and unfavorable 30-day neurologic function. Logistic regression models were calculated to estimate the effect of PCSK–9 levels on the primary outcome, given as odds ratio (OR) and 95% confidence interval (95%CI). PCSK–9 levels on admission were significantly lower in patients with favorable 30-day neurologic function (median 158 ng/mL, (quartiles: 124–225) vs. 207 ng/mL (174–259); <i>p</i> = 0.019). The optimally discriminating PCSK–9 level cut-off was 165 ng/mL. In patients with PCSK–9 levels ≥ 165 ng/mL, the odds of unfavorable neurological outcome were 4.7-fold higher compared to those with PCSK–9 levels < 165 ng/mL. In conclusion, low PCSK–9 levels were associated with favorable neurologic function.https://www.mdpi.com/2077-0383/9/8/2606inflammation mediatorscardiac arrestcardiopulmonary resuscitationcritical care outcomesemergency medicinelipid metabolism |
| spellingShingle | Anne Merrelaar Nina Buchtele Christoph Schriefl Christian Clodi Michael Poppe Florian Ettl Harald Herkner Bernd Jilma Michael Schwameis Christian Schoergenhofer Low PCSK-9 levels Are Associated with Favorable Neurologic Function after Resuscitation from out of Hospital Cardiac Arrest Journal of Clinical Medicine inflammation mediators cardiac arrest cardiopulmonary resuscitation critical care outcomes emergency medicine lipid metabolism |
| title | Low PCSK-9 levels Are Associated with Favorable Neurologic Function after Resuscitation from out of Hospital Cardiac Arrest |
| title_full | Low PCSK-9 levels Are Associated with Favorable Neurologic Function after Resuscitation from out of Hospital Cardiac Arrest |
| title_fullStr | Low PCSK-9 levels Are Associated with Favorable Neurologic Function after Resuscitation from out of Hospital Cardiac Arrest |
| title_full_unstemmed | Low PCSK-9 levels Are Associated with Favorable Neurologic Function after Resuscitation from out of Hospital Cardiac Arrest |
| title_short | Low PCSK-9 levels Are Associated with Favorable Neurologic Function after Resuscitation from out of Hospital Cardiac Arrest |
| title_sort | low pcsk 9 levels are associated with favorable neurologic function after resuscitation from out of hospital cardiac arrest |
| topic | inflammation mediators cardiac arrest cardiopulmonary resuscitation critical care outcomes emergency medicine lipid metabolism |
| url | https://www.mdpi.com/2077-0383/9/8/2606 |
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