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. 2025 Feb;42(1):142-151.
doi: 10.1007/s12028-024-02055-6. Epub 2024 Jul 9.

Application of Phosphorylated Tau for Predicting Outcomes Among Sudden Cardiac Arrest Survivors

Sih-Shiang Huang  1 , Chien-Hua Huang  1 , Nai-Tan Hsu, Hooi-Nee Ong  1 , Jr-Jiun Lin  1 , Yi-Wen Wu, Wei-Ting Chen  1 , Wen-Jone Chen  1   2   3 , Wei-Tien Chang  1 , Min-Shan Tsai  4
Affiliations

Application of Phosphorylated Tau for Predicting Outcomes Among Sudden Cardiac Arrest Survivors

Sih-Shiang Huang et al. Neurocrit Care. 2025 Feb.

Abstract

Background: Phosphorylated Tau (p-Tau), an early biomarker of neuronal damage, has emerged as a promising candidate for predicting neurological outcomes in cardiac arrest (CA) survivors. Despite its potential, the correlation of p-Tau with other clinical indicators remains underexplored. This study assesses the predictive capability of p-Tau and its effectiveness when used in conjunction with other predictors.

Methods: In this single-center retrospective study, 230 CA survivors had plasma and brain computed tomography scans collected within 24 h after the return of spontaneous circulation (ROSC) from January 2016 to June 2023. The patients with prearrest Cerebral Performance Category scores ≥ 3 were excluded (n = 33). The neurological outcomes at discharge with Cerebral Performance Category scores 1-2 indicated favorable outcomes. Plasma p-Tau levels were measured using an enzyme-linked immunosorbent assay, diastolic blood pressure (DBP) was recorded after ROSC, and the gray-to-white matter ratio (GWR) was calculated from brain computed tomography scans within 24 h after ROSC.

Results: Of 197 patients enrolled in the study, 54 (27.4%) had favorable outcomes. Regression analysis showed that higher p-Tau levels correlated with unfavorable neurological outcomes. The levels of p-Tau were significantly correlated with DBP and GWR. For p-Tau to differentiate between neurological outcomes, an optimal cutoff of 456 pg/mL yielded an area under the receiver operating characteristic curve of 0.71. Combining p-Tau, GWR, and DBP improved predictive accuracy (area under the receiver operating characteristic curve = 0.80 vs. 0.71, p = 0.008).

Conclusions: Plasma p-Tau levels measured within 24 h following ROSC, particularly when combined with GWR and DBP, may serve as a promising biomarker of neurological outcomes in CA survivors, with higher levels predicting unfavorable outcomes.

Keywords: Biomarker; Brain; Cardiac arrest; Neuroprognostication; p-Tau.

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Conflict of interest statement

Conflicts of interest: The authors declare no conflict of interest. Ethical approval/informed consent: We confirmed adherence to ethical guidelines and indicate ethical approvals (institutional review board) and use of informed consent, as appropriate. Retrospective studies require a statement regarding institutional review board approval.

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