Ghrelin for neuroprotection in post-cardiac arrest coma: a 1-year follow-up of cognitive and psychosocial outcomes
Year: 2024
Type: article
Abstract: AIMS: Effective treatments to improve brain recovery after cardiac arrest are needed. Ghrelin showed efficacy in experimental models and was associated with lower neuron-specific enolase levels in the clinical Ghrelin in Coma (GRECO) trial. Here, we present cognitive and psychosocial outcomes at 1-year follow-up. METHODS AND RESULTS: GRECO was a Phase 2 multicentre, double-blind, randomized, placebo-controlled trial in comatose patients after cardiac arrest. The intervention was intravenous acyl-ghrelin 600 μg twice daily or placebo for 1 week, starting within 12 h after the arrest. Patients were assessed after 1 year using cognitive tests and questionnaires measuring participation, health-related quality of life, mood, and caregiver strain. Composite z-scores of the cognitive tests were computed by comparing the scores with those of a norm population and averaging the tests for memory, attention, and executive functioning separately. Groups were compared based on composite z-scores and cut-off scores for psychosocial outcomes. Of the 160 participants originally included, 66 of the 85 participants who survived to 1 year after OHCA completed the psychosocial and cognitive follow-up. The intervention group scored numerically higher across the cognitive domains compared with the control group, but the differences were not statistically significant (memory median = -0.850 vs. -1.385, U = 424.5, P = 0.587; attention median = -0.733 vs. -0.717, U = 420.5, P = 0.548; and executive functioning median = -0.311 vs. -0.482, U = 408.5, P = 0.323). There were significantly fewer signs of depression in the intervention group (U = 322.5, P = 0.014). CONCLUSION: This predefined secondary analysis found that ghrelin treatment was associated with non-significantly but consistently better cognitive outcomes and significantly fewer signs of depression. This is in line with the primary outcomes. CLINICAL TRIAL REGISTRATION: Clinicaltrialsregister.eu: EUCTR2018-000005-23-NL.
Authors: Pauline van Gils, Sjoukje Nutma, Karen Meeske, Caroline van Heugten, Walter van den Bergh, Norbert Foudraine, Joost le Feber, Margreet Filius, Michel van Putten, Bert Beishuizen, Jeannette Hofmeijer, for the GRECO investigators, S Nutma, A Beishuizen, W M van den Bergh, N A Foudraine, J le Feber, P M G Filius, A D Cornet, J W Vermeijden, J van der Palen, M J A M van Putten, J Hofmeijer, H B van der Worp, A J C Slooter, M van Smeeden, E Wilms, Martin Rinket, Tim Krol, Rosalie Visser, Esther van Veen, Lucien Gijsbers, Manon Fleuren-Janssen, Michel Kreijtz, Hester Tamminga, Margreet Filius, Martin Rinket, Tim Krol, Wim Addink, Rob Damink, Marlies Snoek-Pecht, Michel Kreijtz, Hester Tamminga, Suzanne Dittrich, Margriet Bosma, Jerôme Appeldoorn, Jolanda Elenbaas, Vera IJmker, Laura de Bever, Ozzy Roesink
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,813
Awards: G1616867387, G452754051, G4603710611
OpenAlex ID: W4403736890