Outcome after cardiac arrest:: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale
Outcome after cardiac arrest:: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale
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DOI：
10.1016/j.resuscitation.2004.10.011
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发表时间：
2005-04-01
期刊：
影响因子：
6.5
通讯作者：
Figulla, HR
中科院分区：
文献类型：
--
作者：
Pfeifer, R;Börner, A;Figulla, HR
背景和目的：从心脏骤停中复苏的患者有随后死亡或神经系统结果不佳直至持续植物人状态的风险。我们研究了 1998 年至 2002 年间 97 名非创伤性心脏骤停后接受心肺复苏 (CPR) 的患者中几种流行病学和临床标志物以及两种神经蛋白（神经元特异性烯醇化酶 (NSE) 和 S-100 蛋白 (S-100)）的预后价值。结果：52.6% 的患者死亡，28.8% 的患者存活下来，其中有严重、中度或无症状。神经系统疾病，18.6%仍处于持续植物人状态。 CPR 后 > 48 小时失去意识，预测神经系统预后不良的风险为 60.6 倍（95% CI 14.3287-257.205，p = 0.001），72 小时后格拉斯哥昏迷量表（GCS）< 6 分，预测神经系统预后不良的风险为 11.2 倍（CI 95%，3.55-36.44，p < 0.001）。 NSE 血清水平 > 65 ng/ml 和 S-100 血清水平 > 1.5 μg/l 会使死亡和持续植物人状态的风险分别增加 16.8 (95% Cl 2.146-131.520) 和 12.6 (95% Cl 1.1093-99.210) 倍。通过将 GCS 与 CPR 后第三天升高的两种神经蛋白血清浓度高于截止水平相结合，可以预测不良的神经学结果，特异性为 100%。 结论：GCS 与 CPR 后 72 It 时两种神经蛋白血清水平的组合可以比单独使用单一标记物更可靠地预测逮捕后昏迷的结果，而与麻醉剂的应用无关。 (c) 2004 Elsevier Ireland Ltd. 保留所有权利。
Background and purpose: Patients resuscitated from cardiac arrest are at risk of subsequent death or poor neurological outcome up to a persistent vegetative state. We investigated the prognostic value of several epidemiological and clinical markers and two neuroproteins, neuron-specific enolase (NSE) and S-100 protein (S-100), in 97 patients undergoing cardiopulmonary resuscitation (CPR) after non-traumatic cardiac arrest between 1998 and 2002.Results: 52.6% of the patients died, 28.8% survived with severe, moderate or without neurological disorders, and 18.6% remained in a persistent vegetative state. Unconsciousness > 48 h after CPR predicted a 60.6-fold (95% Cl 14.3287-257.205, p = 0.001) and a Glasgow Coma Scale (GCS) < 6 points after 72 h a 11.2-fold (CI 95%, 3.55-36.44, p < 0.001) risk of poor neurological outcome. Serum levels > 65 ng/ml for NSE and > 1.5 mu g/l for S-100 increased the risk of death and persistent vegetative state 16.8 (95% Cl 2.146-131.520)- and 12.6 (95% Cl 1.1093-99.210)- fold, respectively. By combination of the GCS with elevated serum concentrations of both neuroproteins above the cut off levels on third day after CPR a poor neurological outcome was predicted with a specificity of 100%.Conclusion: The combination of GCS with the serum levels of both neuroproteins at 72 It after CPR permit a more reliable prediction of outcome in post arrest coma than the single markers alone, independent of the application of anaesthetic agents. (c) 2004 Elsevier Ireland Ltd. All rights reserved.