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Licensed Unlicensed Requires Authentication Published by De Gruyter August 31, 2020

Trimethylamine-N-oxide (TMAO) predicts short- and long-term mortality and poor neurological outcome in out-of-hospital cardiac arrest patients

  • Seraina R. Hochstrasser , Kerstin Metzger , Alessia M. Vincent , Christoph Becker , Annalena K. J. Keller , Katharina Beck , Sebastian Perrig , Kai Tisljar , Raoul Sutter , Philipp Schuetz , Luca Bernasconi , Peter Neyer , Stephan Marsch and Sabina Hunziker EMAIL logo



Prior research found the gut microbiota-dependent and pro-atherogenic molecule trimethylamine-N-oxide (TMAO) to be associated with cardiovascular events as well as all-cause mortality in different patient populations with cardiovascular disease. Our aim was to investigate the prognostic value of TMAO regarding clinical outcomes in patients after out-of-hospital cardiac arrest (OHCA).


We included consecutive OHCA patients upon intensive care unit admission into this prospective observational study between October 2012 and May 2016. We studied associations of admission serum TMAO with in-hospital mortality (primary endpoint), 90-day mortality and neurological outcome defined by the Cerebral Performance Category (CPC) scale.


We included 258 OHCA patients of which 44.6% died during hospitalization. Hospital non-survivors showed significantly higher admission TMAO levels (μmol L−1) compared to hospital survivors (median interquartile range (IQR) 13.2 (6.6–34.9) vs. 6.4 (2.9–15.9), p<0.001). After multivariate adjustment for other prognostic factors, TMAO levels were significantly associated with in-hospital mortality (adjusted odds ratios (OR) 2.1, 95%CI 1.1–4.2, p=0.026). Results for secondary outcomes were similar with significant associations with 90-day mortality and neurological outcome in univariate analyses.


In patients after OHCA, TMAO levels were independently associated with in-hospital mortality and other adverse clinical outcomes and may help to improve prognostication for these patients in the future. Whether TMAO levels can be influenced by nutritional interventions should be addressed in future studies.

Corresponding author: Prof. Sabina Hunziker, MD, MPH, Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; and Faculty of Medicine, University of Basel, Basel, Switzerland, E-mail:
Seraina Rahel Hochstrasser and Kerstin Metzger contributed equally to this article and are considered equally first authors.

Award Identifier / Grant number: 8472/HEG-DSV

  1. Research funding: Gottfried und Julia Bangerter-Rhyner-Stiftung, 8472/HEG-DSV.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The study was conducted in accordance with the Declaration of Helsinki and was approved by the local Ethics Committee (Ethics Committee of Northwest and Central Switzerland, Ethikkommission Nordwest- und Zentralschweiz, EKNZ).


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2020-02-15
Accepted: 2020-08-06
Published Online: 2020-08-31
Published in Print: 2021-02-23

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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