Effects of tocilizumab on neutrophil gelatinase-associated lipocalin following out-of-hospital cardiac arrest, and its prognostic value.

Background: Early risk assessment is crucial in comatose survivors of out-of-hospital cardiac arrest (OHCA) for timely resource allocation and initiation of interventions. Neutrophil gelatinase-associated lipocalin (NGAL) is an inflammatory biomarker found in neutrophils and renal tubules. It detects kidney injury earlier than creatinine. Objectives: To assess the effect of interleukin-6 inhibition, using tocilizumab, on NGAL in comatose survivors of OHCA. We also evaluated the prognostic value of NGAL for the need for continuous renal replacement therapy (cRRT) and all-cause mortality. Methods: This is a substudy of the IMICA trial, a randomized controlled trial including 80 comatose adult survivors from OHCA who were randomized to either infusion of tocilizumab or a placebo.NGAL, markers for injury severity, inflammation, and organ injury were measured serially from 0 to 72 h after admission. The area under the curve (AUC Results: NGAL levels did not differ between the tocilizumab and placebo groups at 0-72 h.At admission, NGAL predicted the need for cRRT with an AUC Conclusion: Tocilizumab did not affect NGAL in comatose survivors of OHCA. NGAL levels at admission were predictive for use of cRRT and death at 180 days.