Evidence map›Paper›PMID 38955930›Full record

ArticleNeurocritical care2025

Cerebrospinal Creatine Kinase BB Isoenzyme: A Biomarker for Predicting Outcome After Cardiac Arrest.

Nicholas J Johnson, Nassim Matin, Amita Singh, Arielle P Davis, Hsuan-Chien Liao, James A Town, David L Tirschwell, Michael G Nash, W T Longstreth, Sandeep P Khot

Abstract read
PubMed Publisher
In one paragraph

Article in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Nicholas J JohnsonDepartment of Emergency Medicine, Harborview Medical Center, University of Washington School of Medicine, University of Washington, 325 Ninth Avenue, Box 359108, Seattle, WA, 98104, USA. nickj45@uw.edu.ORCID 0000-0001-9915-0591
Nassim MatinBarrow Neurological Institute, Phoenix, AZ, USA.
Amita SinghDepartment of Neurology, University of Florida, Gainesville, FL, USA.
Arielle P DavisDepartment of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Hsuan-Chien LiaoDepartment of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.
James A TownDivision of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
David L TirschwellDepartment of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Michael G NashCenter for Biomedical Statistics, University of Washington, Seattle, WA, USA.
W T LongstrethDepartment of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Sandeep P KhotDepartment of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCerebrospinal fluid creatine kinase BB isoenzyme (CSF CK-BB) after cardiac arrest (CA) has been shown to have a high positive predictive value for poor neurological outcome, but it has not been evaluated in the setting of targeted temperature management (TTM) and modern CA care. We aimed to evaluate CSF CK-BB as a prognostic biomarker after CA.

methodsWe performed a retrospective cohort study of patients with CA admitted between 2010 and 2020 to a three-hospital health system who remained comatose and had CSF CK-BB assayed between 36 and 84 h after CA. We examined the proportion of patients at hospital discharge who achieved favorable or intermediate neurological outcome, defined as Cerebral Performance Category score of 1-3, compared with those with poor outcome (Cerebral Performance Category score 4-5) for various CSF CK-BB thresholds. We also evaluated additive value of bilateral absence of somatosensory evoked potentials (SSEPs).

resultsAmong 214 eligible patients, the mean age was 54.7 ± 4.8 years, 72% of patients were male, 33% were nonwhite, 17% had shockable rhythm, 90% were out-of-hospital CA, and 83% received TTM. A total of 19 (9%) awakened. CSF CK-BB ≥ 230 U/L predicted a poor outcome at hospital discharge, with a specificity of 100% (95% confidence interval [CI] 82-100%) and sensitivity of 69% (95% CI 62-76%). When combined with bilaterally absent N20 response on SSEP, specificity remained 100% while sensitivity increased to 80% (95% CI 73-85%). Discordant CK-BB and SSEP findings were seen in 13 (9%) patients.

conclusionsCerebrospinal fluid creatine kinase BB isoenzyme levels accurately predicted poor neurological outcome among CA survivors treated with TTM. The CSF CK-BB cutoff of 230 U/L optimizes sensitivity to 69% while maintaining a specificity of 100%. CSF CK-BB could be a useful addition to multimodal neurological prognostication after CA.

Indexed as

ComaCreatine Kinase, BB FormEvoked Potentials, SomatosensoryHeart ArrestAdultAgedBiomarkersFemaleHumansHypothermia, InducedMaleMiddle AgedPredictive Value of TestsPrognosisRetrospective StudiesBiomarkersCreatine Kinase, BB FormBiomarkersCardiac arrestCreatinine kinaseNeuroprognosticationOHCAOut-of-hospital cardiac arrestPrognosticationTargeted temperature managementTherapeutic hypothermiaTTM

Identifiers

PMID38955930

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.