Galectin-3 Predicts Long-Term Risk of Cerebral Disability and Mortality in Out-of-Hospital Cardiac Arrest Survivors
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Setting
2.2. Patient Enrollment
2.3. Clinical Data Abstraction
2.4. Biomarkers Measurement
2.5. Outcome Measures
2.6. Statistical Analysis
3. Results
3.1. Patient Population
3.2. Biomarkers and Mortality
3.3. Biomarkers and Severe Cerebral Disability
3.4. Incremental Prognostic Value of Biomarkers
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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AMI (n = 30) | OHCA (n = 144) | p Value | |
---|---|---|---|
Baseline Characteristics | |||
Age, years | 64.4 ± 11.7 | 60.8 ± 14.4 | 0.28 |
Gender, % females | 40 | 34.7 | 0.67 |
Risk Factors | |||
HTN, % | 77.8 | 59.3 | 0.19 |
DM, % | 22.2 | 30.0 | 0.59 |
CKD, % | 0 | 18.6 | 0.04 |
Smoking, % | 50 | 51.8 | 1.0 |
Atrial fibrillation, % | 22.2 | 11.4 | 0.25 |
Family history of cardiac arrest, % | 11.1 | 0.72 | 0.03 |
Prior AMI, % | 38.9 | 16.4 | 0.04 |
Prior coronary revascularization, % | 44.4 | 17.2 | 0.012 |
Medications | |||
Aspirin, % | 20.0 | 30.0 | 0.3 |
Statin, % | 55.6 | 42.2 | 0.31 |
Beta Blocker, % | 61.1 | 39.3 | 0.13 |
Aldosterone blocker, % | 0.0 | 3.6 | 1.00 |
ACE/ARBi, % | 50.0 | 32.9 | 0.18 |
Diuretics, % | 16.7 | 25.9 | 0.56 |
Laboratory Values | |||
Hemoglobin, g/dL | 13.3 ± 1.5 | 12.9 ± 2.3 | 0.47 |
Creatinine, mg/dL | 1.0 ± 0.3 | 1.9 ± 1.9 | 0.0005 |
eGFR. mL/min/1.73 m2 | 56.4 ± 5.7 | 48.0 ± 20.4 | 0.02 |
BNP, ng/mL | 259.6 ± 246.1 | 695.6 ± 1213.8 | 0.47 |
Initial CK, U/L | 448.0 ± 538.6 | 1121.5 ± 1649.2 | 0.10 |
CK, U/L | 76.6 ± 151.9 | 95.1 ± 218.3 | 0.90 |
Peak troponin, ng/mL | 79.3 ± 104.2 | 28.3 ± 114.4 | 0.02 |
Serum galectin-3, ng/mL, median (IQR) | 12.68 (9.61–17.39) | 31.48 (17.25–52.60) | <0.0001 |
Echo and ECG Parameters | |||
LVEF post-arrest, % | 50.2 ± 12.3 | 48.1 ± 14.1 | 0.62 |
LVEF < 35%, % | 11.8 | 24.1 | 0.36 |
QTc on initial ECG, ms | 409.4 ± 40.6 | 446.0 ± 53.6 | 0.005 |
Outcomes | |||
All-cause mortality, % | 10.0 | 60.4 | <0.0001 |
Survivors (n = 57) | Non-Survivors (n = 87) | p-Value | |
---|---|---|---|
Baseline Characteristics | |||
Age, years | 56.5 ± 13.5 | 63.6 ± 14.3 | 0.003 |
Female gender, % | 31.5 | 36.7 | 0.59 |
Medications on Presentation | |||
Aspirin, % | 32.4 | 26.1 | 0.46 |
Statin, % | 32.4 | 52.2 | 0.03 |
Beta Blocker, % | 38.0 | 40.6 | 0.86 |
ACEI/ARB, % | 33.8 | 31.9 | 0.86 |
Diuretic, % | 11.4 | 40.6 | <0.0001 |
Aldosterone blocker, % | 3.6 | 5.8 | 0.21 |
Risk Factors | |||
HTN, % | 59.2 | 59.4 | 1.00 |
DM, % | 21.1 | 39.1 | 0.02 |
Smoking, % | 47.9 | 55.9 | 0.39 |
Prior AMI, % | 12.7 | 20.3 | 0.26 |
CKD, % | 9.9 | 27.5 | 0.008 |
Atrial fibrillation, % | 9.9 | 13.0 | 0.60 |
Prior coronary revascularization, % | 16.9 | 17.4 | 1.00 |
Family history of SCA, % | 1.4 | 0 | 1.00 |
Laboratory Values | |||
Hemoglobin, g/dL | 13.7 ± 1.8 | 12.0 ± 2.5 | <0.0001 |
Creatinine, mg/dL | 1.5 ± 1.1 | 2.2 ± 2.5 | 0.04 |
eGFR, mL/min/1.73 m2 | 54.16 ± 12.93 | 44.1 ± 22.2 | 0.008 |
BNP, pg/mL | 231 ± 347 | 1090 ± 1481 | <0.0001 |
CK, U/L | 1160.6 ± 1539.3 | 1080.1 ± 1773.5 | 0.64 |
Peak troponin, ng/mL | 19.7 ± 34.8 | 33.9 ± 143.7 | 0.17 |
Serum galectin-3, ng/mL, median (IQR) | 20.3 (9.2–34.7) | 40.1 (26.6–58.7) | <0.0001 |
Time from event to galectin 3 sample, mins | 295 ± 412.9 | 213.1 ± 297.1 | 0.56 |
Echo and EKG Parameters | |||
LVEF post-arrest, % | 48. 2 ± 12.6 | 48.1 ± 15.5 | 0.57 |
LVEF, <35%, % | 21.4 | 26.9 | 0.54 |
QTc on initial EKG, ms | 432.8 ± 51.9 | 460.1 ± 52.1 | 0.001 |
Event Variables | |||
Duration of resuscitation, mins | 8.8 ± 8.6 | 19.2 ± 18.6 | 0.0001 |
Initial Asystole/PEA rhythm, % | 19.7 | 64.2 | 0.001 |
Variable | Hazard Ratio (95% CI) | p-Value |
---|---|---|
Age | 1.02 (1.004–1.037) | 0.010 |
Galectin-3 | 5.79 (2.88–12.04) | <0.0001 |
BNP | 2.53 (1.67–3.93) | <0.0001 |
Hemoglobin | 0.83 (0.75–0.91) | <0.0001 |
eGFR | 0.987 (0.97–0.99) | 0.030 |
Arterial pH | 0.19 (0.05–0.77) | 0.010 |
Initial rhythm asystole | 4.21 (2.59–7.06) | <0.0001 |
Resuscitation time | 1.022 (1.009–1.032) | <0.0001 |
QTc | 1.004 (1.001–1.007) | 0.009 |
History of diabetes | 1.83 (1.17–2.82) | 0.006 |
History of CKD | 1.716 (1.032–2.74) | 0.029 |
History of diuretic use | 2.42 (1.55–3.75) | <0.0001 |
History of statin use | 1.74 (1.13–2.68) | 0.010 |
Predictor | Hazard Ratio | 95% CI | p-Value |
---|---|---|---|
Galectin-3 | 15.93 | 1.49–191.4 | p = 0.022 |
Resuscitation time | 1.02 | 0.97–1.08 | p = 0.372 |
BNP | 1.17 | 0.43–3.27 | p = 0.745 |
Arterial pH | 0.37 | 0.001–17.58 | p = 0.629 |
Reference Model | Reference + Risk Factor(s) | Reference Model + BNP | Reference Model + pH | Reference Model + Resuscitation Time | Reference Model + Galectin-3 | [Reference Model + Risk Factor(s)] + BNP | [Reference Model + Risk Factor(s)] + Galectin-3 | |
---|---|---|---|---|---|---|---|---|
Log-likelihood ratio | - | p = 0.009 | p = 0.01 | p = 0.014 | p = 0.003 | p < 0.0001 | p = 0.005 | p < 0.0001 |
AIC | 701.3 | 697.8 | 698.6 | 698.7 | 695.3 | 679.8 | 696.4 | 676.4 |
Partial LL | −348.7 | −345.9 | −346.3 | −346.3 | −343.6 | −336.9 | −344.2 | −334.2 |
Discrimination | ||||||||
C-statistic | 0.59 (0.50–0.67) | 0.61 (0.53–0.70) | 0.62 (0.54–0.71) | 0.62 (0.54–0.71) | 0.65 (0.56–0.73) | 0.73 (0.65–0.80) | 0.63 (0.55–0.72) | 0.74 (0.67–0.82) |
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Abdelradi, A.; Mosleh, W.; Kattel, S.; Al-Jebaje, Z.; Tajlil, A.; Pokharel, S.; Sharma, U.C. Galectin-3 Predicts Long-Term Risk of Cerebral Disability and Mortality in Out-of-Hospital Cardiac Arrest Survivors. J. Pers. Med. 2024, 14, 994. https://doi.org/10.3390/jpm14090994
Abdelradi A, Mosleh W, Kattel S, Al-Jebaje Z, Tajlil A, Pokharel S, Sharma UC. Galectin-3 Predicts Long-Term Risk of Cerebral Disability and Mortality in Out-of-Hospital Cardiac Arrest Survivors. Journal of Personalized Medicine. 2024; 14(9):994. https://doi.org/10.3390/jpm14090994
Chicago/Turabian StyleAbdelradi, Amr, Wasim Mosleh, Sharma Kattel, Zaid Al-Jebaje, Arezou Tajlil, Saraswati Pokharel, and Umesh C. Sharma. 2024. "Galectin-3 Predicts Long-Term Risk of Cerebral Disability and Mortality in Out-of-Hospital Cardiac Arrest Survivors" Journal of Personalized Medicine 14, no. 9: 994. https://doi.org/10.3390/jpm14090994