Neutrophil Gelatinase-Associated Lipocalin (NGAL) correlates with time to ROSC, myocardial, kidney and brain markers, and SOFA score in comatose survivors from out-of-hospital cardiac arrest

Abstract Background Early prognostication is vital for risk assessment and resource allocation during the care of patients remaining comatose following out-of-hospital cardiac arrest (OHCA). The biomarker Neutrophil Gelatinase-Associated Lipocalin (NGAL) is a novel prognosticator for early recognition of renal injury and possibly inflammation. However, knowledge of NGAL’s association with other clinically relevant outcomes in OHCA patients is lacking. Purpose This study investigates NGAL’s correlation with time to return of spontaneous circulation (ROSC), myocardial, kidney and brain injury markers and Sequential Organ Failure Assessment (SOFA) score in comatose survivors from OHCA. Methods This study is a single center, randomized controlled trial that included 80 comatose adult survivors from OHCA, entitled the IMICA trial (IL-6 Inhibition for Modulating Inflammation After Cardiac Arrest). At admission, patients were randomized to either a single infusion of tocilizumab (8 mg/kg, max 800mg) or placebo. Myocardial, kidney and brain injury were assessed by troponin-T (TnT), creatinine and Neurofilament Light chain (NFL), respectively, while the SOFA score represented the overall clinical status. NGAL at admission (0h) and serial TnT, creatinine and NFL measurements at 0-72h were used for further analysis. Mean 0-72h levels of TnT, creatinine, NFL and SOFA score were calculated. Spearman's rank correlation determined correlations between NGAL at 0h and (I) time to ROSC, (II) TnT, (III) creatinine, (IV) NFL, and (V) SOFA score. Results NGAL levels did not differ between the tocilizumab and the placebo groups at 0h and 48h (both p>0.20). NGAL correlated significantly with all variables within the tocilizumab and placebo groups, including time to ROSC, TnT, creatinine, NFL, and SOFA score (Table 1). Conclusions This study demonstrated that baseline NGAL correlated significantly with time to ROSC and subsequent markers of organ dysfunction in comatose patients resuscitated from OHCA. Tocilizumab treatment did not affect NGAL levels.