Multi-omics biomarkers in post cardiac arrest syndrome: From pathophysiological mechanisms to the potential prognostication.

Post cardiac arrest Syndrome (PCAS) is a systemic ischemia-reperfusion injury (IRI) that occurs after the return of spontaneous circulation (ROSC), characterized by endothelial dysfunction, systemic inflammatory response syndrome (SIRS), and multiple organ failure (MOF). This review focuses on the pathophysiological mechanisms, dynamic change patterns, and prognostic predictive value of three key categories of biomarkers in PCAS: inflammatory factors, endothelial injury biomarkers, and neuronal injury biomarkers. It covers the dual roles of inflammatory mediators such as Interleukin-6 (IL-6), Interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), and procalcitonin (PCT); the early warning value of syndecan-1 (SDC-1), hyaluronic acid (HA), heparan sulfate (HS) and other endothelial injury markers; as well as the prognostic characteristics of neuronal biomarkers including neuron-specific enolase (NSE), s100 calcium binding protein beta subunit (S100-B), Tau proteins, neurofilament light chain (NFL), ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1), and glial fibrillary acidic protein (GFAP). The review proposes that an integrated strategy of multi-omics and multimodal biomarkers can significantly improve the accuracy of prognostic assessment, thereby providing a new theoretical basis and development direction for the early intervention and individualized treatment of PCAS.