Exploratory study of serum ubiquitin carboxyl-terminal esterase L1 and glial fibrillary acidic protein for outcome prognostication after pediatric cardiac arrest.
Exploratory study of serum ubiquitin carboxyl-terminal esterase L1 and glial fibrillary acidic protein for outcome prognostication after pediatric cardiac arrest.
复制标题
DOI：
10.1016/j.resuscitation.2016.01.024
复制
发表时间：
2016-04
期刊：
影响因子：
6.5
通讯作者：
Kochanek PM
中科院分区：
文献类型：
--
作者：
Fink EL;Berger RP;Clark RS;Watson RS;Angus DC;Panigrahy A;Richichi R;Callaway CW;Bell MJ;Mondello S;Hayes RL;Kochanek PM
脑损伤是小儿心脏骤停后发病和死亡的主要原因。脑损伤的血清生物标志物可能有助于结果的确定。本研究的目的是评估血清泛素羧基末端酯酶-L1（UCH-L1）和胶质细胞酸性蛋白（GFAP）的性质，以分类小儿心脏骤停的结果。单中心前瞻性研究。在心脏骤停后最初72小时内的2个时间点测量儿童（n=19）和健康儿童（对照组，n=43）的血清生物标志物。我们记录了人口统计学和心脏骤停和复苏的细节。我们确定了6个月时血清生物标志物浓度与小儿脑功能分类（PCPC）之间的相关性（有利（PCPC 1-3）或不利（PCPC 4-6））。首次评估（时间点1）发生在心脏骤停后中位数（IQR）10.5（5.5-17.0）h，第二次评估（时间点2）发生在心脏骤停后59.0（54.5-65.0）h。在两个时间点，心脏骤停后儿童的血清UCH-L1均高于对照组（p<0.05）。在时间点2，预后不良的受试者的血清GFAP高于对照组（p<0.05）。在时间点1的血清UCH-L1（AUC 0.782）和在时间点2的UCH-L1和GFAP两者对于结果具有良好的分类准确性（AUC 0.822和0.796），所有p<0.05。初步数据表明，血清UCH-L1和GFAP可能有助于在临床相关时间点预测小儿心脏骤停后的结局，应进行前瞻性验证。
Brain injury is the leading cause of morbidity and death following pediatric cardiac arrest. Serum biomarkers of brain injury may assist in outcome prognostication. The objectives of this study were to evaluate the properties of serum ubiquitin carboxyl-terminal esterase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) to classify outcome in pediatric cardiac arrest. Single center prospective study. Serum biomarkers were measured at 2 time points during the initial 72 h in children after cardiac arrest (n=19) and once in healthy children (controls, n=43). We recorded demographics and details of the cardiac arrest and resuscitation. We determined the associations between serum biomarker concentrations and Pediatric Cerebral Performance Category (PCPC) at 6 months (favorable (PCPC 1–3) or unfavorable (PCPC 4–6)). The initial assessment (time point 1) occurred at a median (IQR) of 10.5 (5.5–17.0) h and the second assessment (time point 2) at 59.0 (54.5–65.0) h post-cardiac arrest. Serum UCH-L1 was higher among children following cardiac arrest than among controls at both time points (p<0.05). Serum GFAP in subjects with unfavorable outcome was higher at time point 2 than in controls (p<0.05). Serum UCH-L1 at time point 1 (AUC 0.782) and both UCH-L1 and GFAP at time point 2 had good classification accuracy for outcome (AUC 0.822 and 0.796), p<0.05 for all. Preliminary data suggest that serum UCH-L1 and GFAP may be of use to prognosticate outcome after pediatric cardiac arrest at clinically-relevant time points and should be validated prospectively.