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September 18, 2026Resuscitation PlusOpen Access

Higher plasma penKid links to ~62% higher odds of poor neurological outcome but adds limited discriminatory value.

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Population

417 adults admitted to intensive care after cardiac arrest in southern Sweden.

Design

Cohort

Follow-up

180 days / 2-6 months

Key result

Higher plasma penKid at admission was associated with poor neurological outcome (OR 1.62; 95% CI 1.15-2.28) and mortality, but added limited discriminatory value beyond clinical predictors.

Authors

BÞBergþóra ÞorgeirsdóttirALAnna LybeckHFHans Friberg

Discussion

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Overview

PenKid was associated with poor outcome but added no discrimination; leaves open whether these biomarkers improve post-arrest prognostication.

Key Points

  • To determine whether serial plasma concentrations of proenkephalin A 119–159 (penKid) and circulating dipeptidyl peptidase 3 (cDPP3) associate with long-term neurological outcome and mortality after cardiac arrest.
  • Conducted a retrospective multicentre cohort study of 417 adults admitted to intensive care following cardiac arrest in southern Sweden.
  • Measured plasma penKid and cDPP3 concentrations on admission, at 12 hours, and at 48 hours post-arrest.
  • Evaluated primary outcome of poor neurological outcome (Cerebral Performance Category 3–5 at 2–6 months) and secondary outcome of 180-day mortality using models adjusted for established peri-arrest prognostic variables.
  • Poor neurological outcome occurred in 271 of 417 patients (65%) and 266 of 417 (64%) died within 180 days.
  • Elevated penKid independently associated with poor neurological outcome at admission (aOR 1.62, 95% CI 1.15–2.28) and at 12 hours (aOR 1.50, 95% CI 1.08–2.09), as well as 180-day mortality at admission (aHR 1.36, 95% CI 1.20–1.54) and 12 hours (aHR 1.33, 95% CI 1.17–1.51).
  • Elevated cDPP3 independently associated with 180-day mortality at 12 hours (aHR 1.26, 95% CI 1.11–1.43) but not with poor neurological outcome, and neither biomarker significantly improved discrimination beyond the clinical reference model.

Study Design

Type

Cohort (n=417)

Multicenter

Yes

Structured PICO

P
Population
417 adults admitted to intensive care after cardiac arrest in southern Sweden, followed for 2-6 months to evaluate the prognostic value of penKid and cDPP3 biomarkers.
E
Exposure
Serial plasma proenkephalin A 119–159 (penKid) and circulating dipeptidyl peptidase 3 (cDPP3) measured on admission, 12, and 48 hours
O
Outcome
Poor neurological outcome, defined as Cerebral Performance Category 3–5 at 2–6 monthshard clinical

Main Result

Odds Ratio: 1.62 (95% CI 1.15–2.28)

Early penKid and cDPP3 levels are associated with poor neurological outcome and mortality after cardiac arrest but do not add discriminatory value beyond established clinical predictors.

Cite This Study

Þorgeirsdóttir et al. (2026) conducted a cohort in cardiac arrest (n=417). Plasma proenkephalin A 119–159 (penKid) and circulating dipeptidyl peptidase 3 (cDPP3) was evaluated on Poor neurological outcome (Cerebral Performance Category 3–5) at 2–6 months (OR 1.62, 95% CI 1.15-2.28). Higher plasma penKid at admission was associated with poor neurological outcome (OR 1.62; 95% CI 1.15-2.28) and mortality, but added limited discriminatory value beyond clinical predictors.

synapsesocial.com/papers/6aacf5ed0c46fbdff987dd5bhttps://doi.org/10.1016/j.resplu.2026.101496
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