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Low Plasma Sphingomyelin Levels Show a Weak Association with Poor Neurological Outcome in Cardiac Arrest Patients: Results from the Prospective, Observational COMMUNICATE Trial

1
Intensive Care Unit, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
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Medical Communication and Psychosomatic Medicine, University Hospital Basel, 4031 Basel, Switzerland
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Institute of Laboratory Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland
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Medical faculty of the University of Basel, 4001 Basel, Switzerland
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Department of Internal Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland
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Department of Neurology, University Hospital Basel, 4031 Basel, Switzerland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(4), 897; https://doi.org/10.3390/jcm9040897 (registering DOI)
Received: 15 February 2020 / Revised: 9 March 2020 / Accepted: 16 March 2020 / Published: 25 March 2020
(This article belongs to the Section Emergency Medicine)
There is interest in novel blood markers to improve risk stratification in patients presenting with cardiac arrest. We assessed associations of different plasma sphingomyelin concentrations and neurological outcome in patients with cardiac arrest. In this prospective observational study, adult patients with cardiac arrest were included upon admission to the intensive care unit (ICU). We studied associations of admission plasma levels of 15 different sphingomyelin species with neurological outcome at hospital discharge (primary endpoint) defined by the modified Rankin Scale by the calculation of univariable and multivariable logistic regression models adjusted for age, gender, and clinical shock markers. We included 290 patients (72% males, median age 65 years) with 162 (56%) having poor neurological outcome at hospital discharge. The three sphingomyelin species SM C24:0, SM(OH) C22:1, and SM(OH) C24:1 were significantly lower in patients with poor neurological outcome compared to patients with favorable outcome with areas under the curve (AUC) of 0.58, 0.59, and 0.59. SM(OH) C24:1 was independently associated with poor neurological outcome in a fully-adjusted regression model (adjusted odds ratio per log-transformed unit increase in SM(OH) C24:1 blood level 0.18, 95% CI 0.04 to 0.87, p = 0.033). Results were similar for 1-year mortality. Low admission sphingomyelin levels showed a weak association with poor neurological outcome in patients after cardiac arrest. If validated in future studies, a better understanding of biological sphingomyelin function during cardiac arrest may help to further advance the therapeutic approach and risk stratification in this vulnerable patient group. View Full-Text
Keywords: sphingomyelin; cardiac arrest; neurological outcome sphingomyelin; cardiac arrest; neurological outcome
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Boerlin, A.; Luescher, T.; Becker, C.; Perrig, S.; Thommen, E.; Widmer, M.; Beck, K.; Vincent, A.; Tisljar, K.; Bernasconi, L.; Neyer, P.; Schuetz, P.; Sutter, R.; Marsch, S.; Hunziker, S. Low Plasma Sphingomyelin Levels Show a Weak Association with Poor Neurological Outcome in Cardiac Arrest Patients: Results from the Prospective, Observational COMMUNICATE Trial. J. Clin. Med. 2020, 9, 897.

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