Neurocritical Care

, Volume 12, Issue 2, pp 252–257 | Cite as

Comparison of the Predictability of Neurological Outcome by Serum Procalcitonin and Glial Fibrillary Acidic Protein in Postcardiac-Arrest Patients

  • Hiromi Hayashida
  • Tadashi KanekoEmail author
  • Shunji Kasaoka
  • Chiyomi Oshima
  • Takashi Miyauchi
  • Motoki Fujita
  • Yasutaka Oda
  • Ryosuke Tsuruta
  • Tsuyoshi Maekawa
Original Article



In past research, procalcitonin (PCT) and glial fibrillary acidic protein (GFAP) have been reported to be useful biomarkers in predicting neurological outcome after the return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (CA), although they have only been studied separately. In this study, we compared the usefulness of PCT and GFAP in predicting neurological outcome.


This study was a retrospective, single-center analysis, conducted in the intensive-care unit of a university hospital. Twenty-one sequential post-CA patients were included. Serum samples were collected from patients at 12 and 24 h after ROSC. Serum PCT and GFAP were measured and compared in patients with favorable and unfavorable neurological outcomes, evaluated at 6 months using the Glasgow–Pittsburgh Cerebral Performance Categories.


Serum PCT was significantly higher at 12 and 24 h in patients with unfavorable outcomes (P = 0.004 and 0.002, respectively). Serum GFAP was not significantly higher at 12 and 24 h in patients with unfavorable outcomes (P = 0.118 and 0.079, respectively). The combination of PCT and GFAP showed high predictive value for unfavorable outcomes (86.7% sensitivity and 100% specificity at 12 h; 100% sensitivity and 83.3% specificity at 24 h).


Serum PCT is a marker of unfavorable neurological outcome in post-CA patients, and is superior to serum GFAP in the early phase.


Neurological outcome Cardiac arrest Brain damage Procalcitonin Glial fibrillary acidic protein 



This clinical study was supported by a research project grant from the Japanese Ministry of Health, Labor, and Welfare (number 19791329). We are grateful to Hitomi Ikemoto for her valuable technical assistance in all measurements. We also express our thanks to Masako Ueda for assistance in completing the grant-related paperwork.

Conflict of Interest Statement

This study was conducted independently of the funding bodies, except for a governmental grant. This grant had no influence on the decisions relating to the study design or publication.


  1. 1.
    Fries M, Kunz D, Gressner AM, Rossaint R, Kuhlen R. Procalcitonin serum levels after out-of-hospital cardiac arrest. Resuscitation. 2003;59:105–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Kaneko T, Kasaoka S, Miyauchi T, et al. Serum glial fibrillary acidic protein as a predictive biomarker of neurological outcome after cardiac arrest. Resuscitation. 2009;80:790–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis. 2007;7:210–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Adrie C, Adib-Conquy M, Laurent I, et al. Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome. Circulation. 2002;106:562–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Pelinka LE, Kroepfl A, Schmidhammer R, et al. Glial fibrillary acidic protein in serum after traumatic brain injury and multiple trauma. J Trauma. 2004;57:1006–12.CrossRefPubMedGoogle Scholar
  6. 6.
    Pelinka LE, Kroepfl A, Leixnering M, Buchinqer W, Raabe A, Redl H. GFAP versus S100B in serum after traumatic brain injury: relationship to brain damage and outcome. J Neurotrauma. 2004;21:1553–61.CrossRefPubMedGoogle Scholar
  7. 7.
    Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1:480–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Brunkhorst FM, Wegscheider K, Forycki ZF, Brunkhorst R. Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock. Intensive Care Med. 2000;26:S148–52.PubMedGoogle Scholar
  9. 9.
    Tiainen M, Roine RO, Pettilä V, Takkunen O. Serum neuron-specific enolase and S-100B protein in cardiac arrest patients treated with hypothermia. Stroke. 2003;34:2881–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Oppert M, Reinicke A, Müller C, Barckow D, Frei U, Eckardt KU. Elevations in procalcitonin but not C-reactive protein are associated with pneumonia after cardiopulmonary resuscitation. Resuscitation. 2002;53:167–70.CrossRefPubMedGoogle Scholar
  11. 11.
    Pfeifer R, Börner A, Krack A, Siqusch HH, Suber R, Fiqulla HR. Outcome after cardiac arrest: predictive value and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow coma scale. Resuscitation. 2005;65:49–55.CrossRefPubMedGoogle Scholar
  12. 12.
    Böttiger BW, Möbes S, Glätzer R, et al. Astroglial protein S-100 is an early and sensitive marker of hypoxic brain damage and outcome after cardiac arrest in humans. Circulation. 2001;103:2694–8.PubMedGoogle Scholar
  13. 13.
    Hachimi-Idrissi S, Van derAuwera M, Schiettecatte J, Ebinger G, Michotte Y, Huyghens L. S-100 protein as early predictor of regaining consciousness after out of hospital cardiac arrest. Resuscitation. 2002;53:251–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Pelinka LE, Hertz H, Mauritz W, et al. Nonspecific increase of systemic neuron-specific enolase after trauma: clinical and experimental findings. Shock. 2005;24:119–23.CrossRefPubMedGoogle Scholar
  15. 15.
    Pelinka LE, Harada N, Szalay L, Jafarmadar M, Redl H, Bahrami S. Release of S100B differs during ischemia and reperfusion of the liver, the gut, and the kidney in rats. Shock. 2004;21:72–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Kaneko T, Yagi T, Todani M, et al. Serum glial fibrillary acidic protein has remarkable diagnostic value on traumatic brain injury in multiple trauma patients. Crit Care Med. 2008;36:47.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Hiromi Hayashida
    • 1
  • Tadashi Kaneko
    • 1
    Email author
  • Shunji Kasaoka
    • 1
  • Chiyomi Oshima
    • 1
  • Takashi Miyauchi
    • 1
  • Motoki Fujita
    • 1
  • Yasutaka Oda
    • 1
  • Ryosuke Tsuruta
    • 1
  • Tsuyoshi Maekawa
    • 1
  1. 1.Advanced Medical Emergency and Critical Care Center (AMEC3), Yamaguchi University HospitalYamaguchiJapan

Personalised recommendations