Monocyte subsets predict mortality after cardiac arrest.
Monocyte subsets predict mortality after cardiac arrest.
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单核细胞亚群预测心脏骤停后的死亡率
DOI：
10.1002/jlb.5a0420-231rr
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发表时间：
2021-06
影响因子：
5.5
通讯作者：
Speidl WS
中科院分区：
文献类型：
--
作者：
Krychtiuk KA;Lenz M;Richter B;Hohensinner PJ;Kastl SP;Mangold A;Huber K;Hengstenberg C;Wojta J;Heinz G;Speidl WS
在成功的心肺复苏术(CPR)后，许多患者表现出免疫过度激活的迹象。单核细胞是一种异质性细胞群体，通过流式细胞术可以将其分为三个亚群(经典单核细胞[CM：CD14++CD16-]、中间单核细胞[IM：CD14++CD16+CCR2+]和非经典单核细胞[NCM：CD14+CD16+CCR2-])。包括53名心脏骤停后进入内科重症监护病房(ICU)的患者。入院时和72小时后采血。本研究的主要终点是6个月后的存活，次要终点是由6个月时的脑功能分类(CPC)评分确定的神经结局。中位年龄为64.5(49.8-74.3)岁，男性占75.5%。6个月死亡率为50.9%，神经功能恢复良好的存活率为37.7%。单核细胞亚群在入住ICU时的分布并不因存活率而异。入院后72小时内死亡的患者与存活者相比，IM促炎亚群的比例较高(8.3%[3.8-14.6]%对4.1%[1.5-8.2]%；P=0.025)，CM的比例较低(87.5%[79.9-89.0]%对90.8%[85.9-92.7]%；P<0.036)。此外，IM对预后的预测独立于发生ROSC和心脏骤停的时间，并与6个月时的CCP评分相关(R=0.32；P=0.043)。这些发现提示先天免疫系统可能在心脏骤停后综合征的病理生理学中发挥作用。在心脏骤停后住进ICU的患者中，72小时后中间单核细胞的增加与不良结局相关。
After successful cardiopulmonary resuscitation (CPR), many patients show signs of an overactive immune activation. Monocytes are a heterogeneous cell population that can be distinguished into 3 subsets by flow cytometry (classical monocytes [CM: CD14++CD16‐], intermediate monocytes [IM: CD14++CD16+CCR2+] and non‐classical monocytes [NCM: CD14+CD16++CCR2‐]). Fifty‐three patients admitted to the medical intensive care unit (ICU) after cardiac arrest were included. Blood was taken on admission and after 72 h. The primary endpoint of this study was survival at 6 months and the secondary endpoint was neurological outcome as determined by cerebral performance category (CPC)‐score at 6 months. Median age was 64.5 (49.8‐74.3) years and 75.5% were male. Six‐month mortality was 50.9% and survival with good neurological outcome was 37.7%. Monocyte subset distribution upon admission to the ICU did not differ according to survival. Seventy‐two hours after admission, patients who died within 6 months showed a higher percentage of the pro‐inflammatory subset of IM (8.3% [3.8‐14.6]% vs. 4.1% [1.5–8.2]%; P = 0.025), and a lower percentage of CM (87.5% [79.9–89.0]% vs. 90.8% [85.9–92.7]%; P = 0.036) as compared to survivors. In addition, IM were predictive of outcome independent of time to ROSC and witnessed cardiac arrest, and correlated with CPC‐score at 6 months (R = 0.32; P = 0.043). These findings suggest a possible role of the innate immune system in the pathophysiology of post cardiac arrest syndrome. In patients admitted to an ICU after surviving a cardiac arrest, an increase of intermediate monocytes after 72 hours was associated with poor outcome.