International Journal of Clinical Case Reports, 2025, Vol.15, No.6, 259-270 http://medscipublisher.com/index.php/ijccr 264 Recent studies support the integration of biomarker data into multimodal prognostic algorithms, and the combination of clinical, biochemical, neurophysiological and imaging data for outcome prediction (Humaloja et al., 2022; Sandroni et al., 2023). For example, the combination of NSE or GFAP with electroencephalogram or imaging results can significantly improve the accuracy of mortality and neurological prognosis prediction in adult and pediatric populations (Anetakis et al., 2022). With the accumulation of evidence and the advancement of analytical techniques, the routine application of molecular monitoring in ED is expected to become an important component of individualized post-CPR care, enabling evidence-based timely decision-making to better improve patient prognosis and optimize resource utilization. 5 Ed Biomarkers to Guide Care Strategies 5.1 Biomarker-guided risk stratification and pathways Incorporating brain injury biomarkers into the workflow of the emergency department (ED) can more accurately determine the risk level of patients after cardiopulmonary resuscitation (CPR). Neuro-specific enolase (NSE), S100B, filament light chain (NfL), glial fibrillary acidic protein (GFAP), and ubiquitin carboxyl-terminal hydrolase L1 (UK-L1) are all closely related to neural recovery. Doctors can divide patients into high-risk groups and low-risk groups based on these indicators (Moseby-Knappe et al., 2021; Hoiland et al., 2022). For instance, within the first 72 hours after cardiac arrest, if the NfL, tau and GFAP indicators are normal, it basically indicates that the neurological recovery will be good. If these indicators keep rising, the risk of adverse consequences will be greater (Fink et al., 2022; Kaminoska et al., 2025). This risk classification can help doctors identify patients who need enhanced neuroprotective treatment at an early stage and also indicate whether to adjust the intensive treatment plan. Using biomarkers to guide diagnosis and treatment can also solve the problem of "unclear prognosis" in traditional clinical standards. Integrating the detection of multiple biomarkers into the existing care process can reduce the risk of premature cessation of life support and avoid delaying patients with potential for recovery (Table 1) (Moseby-Knappe et al., 2021; Hoiland et al., 2022; Kamaniska et al., 2025). The use of new markers such as calcitonin 2 can deepen the understanding of neuroinflammation and injury, further optimize risk assessment, and help doctors formulate more precise personalized care plans (Yao et al., 2025). Table 1 Prognostic accuracies in patients with indeterminate outcome according to the ERC/ESICM algorithm (Adopted from Moseby-Knappe et al., 2021) - Sensitivity Specificity NPV PPV TN FN TP FP N NSE 17 ng/mL 89.9 (84.6-93.5) 35.3 (28.8-42.3) 78.8 (69-86.2) 56.5 (50.7-62.2) 67 18 160 123 368 S100B 0.105 µg/L 72.6 (65.7-78.6) 55.5 (48.4-62.4) 68.4 (60.7-75.2) 60.5 (53.8-66.8) 106 49 130 85 370 NFL 55 pg/mL 96.3 (92.5-98.2) 38.7 (32.1-45.7) 91.5 (83.4-95.8) 60.3 (54.7-65.7) 75 7 181 119 382 GFAP 22 pg/mL 97.3 (93.9-98.9) 26.4 (20.7-33.1) 91.1 (80.7-96.1) 56.3 (50.9-61.6) 51 5 183 142 381 Tau 1.55 pg/mL 95.7 (91.8-97.8) 19.6 (14.6-25.7) 82.6 (69.3-90.9) 53.6 (48.2-58.8) 38 8 180 156 382 UCH-L1 327 pg/mL 85 (79.2-89.4) 47.7 (40.7-54.7) 76.7 (68.4-83.3) 61.1 (55.1-66.9) 92 28 159 101 380 Table caption: TN true negative (low biomarker levels in good outcome patients), FN false negative (low biomarker levels in poor outcome patients), TP true positive (high biomarker levels in poor outcome patients), FP false positive (high biomarker levels in good outcome patients), NPV negative predictive value (amount of good outcome patients with normal serum concentrations), PPV positive predictive value (amount of poor outcome patients with abnormal serum concentrations), N = number of samples 5.2 Comprehensive brain protection nursing strategies The data of biomarkers can provide key references for systematic brain protection methods. By identifying high-risk patients of hypoxic-ischemic brain injury at an early stage through it, precise body temperature management can be carried out in a timely manner, blood circulation can be improved, and subsequent injuries such as hypoxia, excessive carbon dioxide in the blood, and low blood pressure can be avoided (Perkins et al., 2024). Based on the changes in biomarkers, the nursing team can prioritize these tasks: maintaining a stable body temperature, ensuring adequate oxygen supply, and closely monitoring issues such as epileptic seizures that may aggravate brain injury (Perkins et al., 2021; Sandroni et al., 2023).
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