(1519) Blood and Imaging Biomarkers Prognosticate Outcome Differently by Pediatric Cardiac Arrest Location

Tuesday, February 25, 2025

8:45am – 9:45am Eastern Time

Location: Connections Central - RST 10

First Author(s)

Hugues Yver, MD (he/him/his)

UPMC Children's Hospital of Pittsburgh, USA

Co-Author(s)

Victor Talisa, PhD (he/him/his)

Research Assistant Professor
Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania, United States
Patrick M. Kochanek, MD, MCCM

Distinguished Professor of Critical Care Medicine
UPMC Presbyterian
Pittsburgh, Pennsylvania, United States
AP

Ashok Panigrahy, MD

John F. Caffey Endowed Chair of Pediatric Radiology, UPMC Children’s Hospital of Pittsburgh
Department of Radiology, UPMC Children's Hospital of Pittsburgh, United States
SB

Sue Beers, PhD

Professor of Psychiatry, University of Pittsburgh School of Medicine
Department of Psychiatry, University of Pittsburgh School of Medicine, United States
AT

Amery Treble, PhD

Assistant Professor
Department of Psychiatry, University of Pittsburgh School of Medicine, United States
CW

Chunyan Wang, N/A

Epidemiologist
Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, United States
AF

Anthony Fabio, PhD, MPH

Associate Professor
Department of Epidemiology, University of Pittsburgh School of Medicine, United States
RC

Robert Clark, MD, FCCM

MD
Childrens Hospital of Pittsburgh of UPMC, Pennsylvania, United States
EF

Ericka Fink, MD, FCCM

Professor of Critical Care Medicine, Pediatrics, and Clinical and Translational Science
Childrens Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, United States

Introduction: Early blood-based brain injury biomarkers and brain magnetic resonance imaging (MRI) features discriminate outcomes after pediatric cardiac arrest (CA), but their prognostic accuracy by CA location remains unknown.

Methods: A secondary analysis of Personalizing Outcomes after Child Cardiac Arrest study, which enrolled children < 18y after an in- (IH) or out-of-hospital (OH) CA at 14 centers. Glial fibrillary acidic protein (GFAP), ubiquitin carboxyl-terminal esterase L1 (UCH-L1), neurofilament light (NfL) and tau proteins were measured on days 1-3 post-CA. Brain MRIs performed ≤14d post-CA were scored by MRI Injury Score, a sum of T2- and diffusion-weighted imaging lesions in gray and white matter. Multivariable logistic regression analyses, adjusted for clinical characteristics, CA etiology and PIM-3 score, were performed to determine association with unfavorable outcome (death or survival with a Vineland Adaptive Behavior Scale < 70) at 1y by CA location.

Results: Of 120 children with primary outcomes available, 60 had an OHCA. Patients with OHCA were older, had more asphyxia etiology of CA and more unfavorable outcomes than those with IHCA (58% vs 25%, p< 0.05). Among children with OHCA, all 4 biomarkers were increased on d1-3 in those with unfavorable outcome (p < 0.05). Adjusted odds ratios (aORs) calculated in the OHCA group showed that NfL on d1-3 (d1: aOR=2.1, 95% CI [1.1-4.0]; d2: 6.9 [1.6-29.3]; d3: 21.3 [1.3-345.8]), UCH-L1 on d1-2 (d1: 1.9 [1.1-3.5]; d2: 13.3 [1.7-104.1]), GFAP on d2-3 (d1: 1.7 [1.1-2.5]; d3: 1.8 [1.1-3.0]) and tau on d1-3 (d1: 1.7 [1.1-2.7]; d2: 2.0 [1.2-3.1]; d3: 2.9 [1.2-7.0]) were associated with an unfavorable outcome. After IHCA, NfL on d1-2 (d1: 2.4 [1.1-5.3]; d2: 2.4 [1.1-5.2]) was associated with unfavorable outcome. MRI Injury Score was increased in the OHCA (median [IQR], 8 [0-27] vs 3 [0-6], p< 0.05) vs IHCA group. In OHCA but not IHCA, multivariable regression showed that MRI Injury Score (aOR=1.12 [1.01-1.23]) was associated with unfavorable outcome.

Conclusions: Brain injury biomarkers and MRI Injury Score were differently associated with unfavorable outcome at 1y after pediatric CA by CA location, suggesting the need for differential use of these based on CA location. The impact of CA severity and etiology on these outcomes also merits further study.