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Purpose. After a cardiac arrest, it is important to predict the neurological outcome of the patients, that is, how well their brain functions will recover. To do this, doctors use different tests, such as measuring the electrical activity of the brain, the level of a protein called NSE in the blood, and the response of the patients to stimuli. Recently, some studies have suggested that another type of molecule in the blood, called microRNA (miRNA), may also help in predicting the neurological outcome after cardiac arrest. MiRNAs are small molecules that do not code for proteins, but regulate the expression of other genes by binding to their messenger RNAs (mRNAs) and preventing them from being translated into proteins. MiRNAs are involved in many biological processes and diseases, and their levels can change in response to different conditions. In this study, we focused on one specific miRNA, called miR-574-5p, and we tested whether its level in the blood can predict the neurological outcome after cardiac arrest. We also examined whether this prediction is different for women and men. Methods. We used data from a previous clinical trial, called the Target Temperature Management (TTM) Trial, which enrolled 950 patients who had a cardiac arrest and were treated with different temperatures to reduce brain damage. For this study, we selected 590 patients who had blood samples available for analysis. We measured the expression level of miR-574-5p in plasma samples that were collected 48 hours after the cardiac arrest, using a technique called quantitative PCR that amplifies and detects specific DNA sequences. We then compared the expression level of miR-574-5p with the neurological outcome of the patients at 6 months after the cardiac arrest. The neurological outcome was assessed using a scale called cerebral performance category (CPC), which ranges from 1 (good recovery) to 5 (brain death). We considered a poor neurological outcome as having a CPC score of 3 (severe disability), 4 (coma or vegetative state), or 5 (brain death). Results. Out of the 590 patients in our study, 81% were men and 49% had a poor neurological outcome at 6 months. We found that the level of miR-574-5p in the blood at 48 hours was higher in patients who had a poor neurological outcome than in those who had a good outcome (), both for women and for men. We also found that the level of miR-574-5p was associated with the risk of having a poor neurological outcome in a statistical analysis (odds ratio (OR) [95% confidence interval (CI)]: 1.5 [1.26-1.78]). This means that for every unit increase in miR-574-5p expression level, there was a 1.5 times higher chance of having a poor neurological outcome. However, when we adjusted this analysis with other clinical variables and NSE level, we found that miR-574-5p was only predictive of neurological outcome for women (OR [95% CI]: 1.9 [1.09-3.45]), but not for men (OR [95% CI]: 1.0 [0.74-1.28]). This means that miR-574-5p was more specific and accurate for predicting neurological outcome in women than in men. Conclusion. Our study shows that miR-574-5p is associated with neurological outcome after cardiac arrest in women. This suggests that miR-574-5p may be a useful biomarker to help doctors predict how well women will recover their brain functions after a cardiac arrest.

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