Serum markers of brain injury can predict good neurological outcome after out-of-hospital cardiac arrest.
Serum markers of brain injury can predict good neurological outcome after out-of-hospital cardiac arrest.
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DOI：
10.1007/s00134-021-06481-4
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发表时间：
2021-09
影响因子：
38.9
通讯作者：
Cronberg T
中科院分区：
文献类型：
--
作者：
Moseby-Knappe M;Mattsson-Carlgren N;Stammet P;Backman S;Blennow K;Dankiewicz J;Friberg H;Hassager C;Horn J;Kjaergaard J;Lilja G;Rylander C;Ullén S;Undén J;Westhall E;Wise MP;Zetterberg H;Nielsen N;Cronberg T
大多数心脏骤停(CA)后的昏迷患者不符合可能的不良结局的指导标准，他们的预后被认为是“不确定的”。我们比较了血液中的脑损伤标记物，以预测良好的结果，并根据指南的建议识别不良结果的假阳性预测。在院外心脏骤停(TTM)试验的目标体温管理范围内，对在心脏骤停后24、48和72小时前瞻性收集的血清样本进行回顾性分析。对临床可用的神经元烯醇化酶(NSE)和S100B，以及新的神经丝轻链(NFL)、总tau、泛素羧基末端水解酶L1(UCH-L1)和胶质纤维酸性蛋白(GFAP)进行了分析。使用参考实验室指定或文献定义的具有先验截止值的正常水平来预测6个月后的良好结果(无至中度残疾，脑功能分类1-2)。共纳入717例患者。正常的NFL、tau和GFAP的敏感性最高(97.2-98%的不良预后患者血清水平异常)，NPV(正常水平预示87-95%的患者预后良好)。正常S100B和NSE预测预后良好，NPV为76-82.2%。正常的NSE在按指南分类为“不确定结果”的患者中，正确识别出67/190(35.3%)的患者预后良好。5名生物标记物正常但有单一病理预后结果的患者预后良好。血液中低水平的脑损伤标志物与CA术后良好的神经预后相关。将生物标记物纳入神经预测可能有助于防止生命维持治疗的过早退出。网上版载有补充材料，可在10.1007/s00134021-06481-4查阅。
The majority of unconscious patients after cardiac arrest (CA) do not fulfill guideline criteria for a likely poor outcome, their prognosis is considered “indeterminate”. We compared brain injury markers in blood for prediction of good outcome and for identifying false positive predictions of poor outcome as recommended by guidelines. Retrospective analysis of prospectively collected serum samples at 24, 48 and 72 h post arrest within the Target Temperature Management after out-of-hospital cardiac arrest (TTM)-trial. Clinically available markers neuron-specific enolase (NSE) and S100B, and novel markers neurofilament light chain (NFL), total tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) were analysed. Normal levels with a priori cutoffs specified by reference laboratories or defined from literature were used to predict good outcome (no to moderate disability, Cerebral Performance Category scale 1–2) at 6 months. Seven hundred and seventeen patients were included. Normal NFL, tau and GFAP had the highest sensitivities (97.2–98% of poor outcome patients had abnormal serum levels) and NPV (normal levels predicted good outcome in 87–95% of patients). Normal S100B and NSE predicted good outcome with NPV 76–82.2%. Normal NSE correctly identified 67/190 (35.3%) patients with good outcome among those classified as “indeterminate outcome” by guidelines. Five patients with single pathological prognostic findings despite normal biomarkers had good outcome. Low levels of brain injury markers in blood are associated with good neurological outcome after CA. Incorporating biomarkers into neuroprognostication may help prevent premature withdrawal of life-sustaining therapy. The online version contains supplementary material available at 10.1007/s00134-021-06481-4.
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影响因子：
9.9
作者：
Mattsson N;Zetterberg H;Janelidze S;Insel PS;Andreasson U;Stomrud E;Palmqvist S;Baker D;Tan Hehir CA;Jeromin A;Hanlon D;Song L;Shaw LM;Trojanowski JQ;Weiner MW;Hansson O;Blennow K;ADNI Investigators
通讯作者：
ADNI Investigators
影响因子：
38.9
作者：
Moseby-Knappe M;Westhall E;Backman S;Mattsson-Carlgren N;Dragancea I;Lybeck A;Friberg H;Stammet P;Lilja G;Horn J;Kjaergaard J;Rylander C;Hassager C;Ullén S;Nielsen N;Cronberg T
通讯作者：
Cronberg T
影响因子：
15.1
作者：
During, Joachim;Annborn, Martin;Nielsen, Niklas
通讯作者：
Nielsen, Niklas
影响因子：
48
作者：
Bazarian, Jeffrey J.;Biberthaler, Peter;Jagoda, Andy S.
通讯作者：
Jagoda, Andy S.
影响因子：
6.5
作者：
Dragancea, Irina;Horn, Janneke;Cronberg, Tobias
通讯作者：
Cronberg, Tobias