The prognostic value of neurofilament levels in patients with sepsis-associated encephalopathy - A prospective, pilot observational study
The prognostic value of neurofilament levels in patients with sepsis-associated encephalopathy - A prospective, pilot observational study
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DOI：
10.1371/journal.pone.0211184
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发表时间：
2019-01-24
期刊：
影响因子：
3.7
通讯作者：
Sauer, Martin
中科院分区：
文献类型：
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作者：
Ehler, Johannes;Petzold, Axel;Sauer, Martin
脓毒症相关性脑病(SAE)是导致脓毒症患者死亡和神经认知功能障碍的重要因素。脓毒症相关性脑病(SAE)患者脑脊液(CSF)和血浆中神经细丝(NF)、轻(NFL)和重(NFH)链水平作为神经轴突损伤的生物标志物未见报道。我们进行了一项前瞻性的先导性观察研究，其中包括20名感染性休克患者和5名非脓毒症患者作为对照。对SAE的评估包括神经精神检查、脑电(EEG)、磁共振成像(MRI)和精神障碍筛查方法，包括ICU混淆评估方法(CAM-ICU)和重症监护精神障碍筛查表(ICDSC)。在纳入研究的第1天、第3天和第7天，对脓毒症患者进行脑脊液神经营养因子测定，并对所有参与者进行纵向血浆神经营养因子测定。脓毒症患者的血浆神经营养因子水平随着时间的推移而升高(p=0.0063)，而在非脓毒症患者中保持稳定。血浆NFL值在SAE患者中显著升高(p=0.011)，与ICDSC值所代表的SAE严重程度显著相关(R=0.534，p=0.022)，并与100d后功能预后不良相关(R=-0.535，p=0.0003)。SAE患者脑脊液中有较高水平的神经营养因子。死亡患者脑脊液中神经营养因子水平高于存活患者(P=0.012)，且与死亡天数相关(R=-0.932，P
Sepsis-associated encephalopathy (SAE) contributes to mortality and neurocognitive impairment of sepsis patients. Neurofilament (Nf) light (NfL) and heavy (NfH) chain levels as biomarkers for neuroaxonal injury were not evaluated in cerebrospinal fluid (CSF) and plasma of patients with sepsis-associated encephalopathy (SAE) before. We conducted a prospective, pilot observational study including 20 patients with septic shock and five patients without sepsis serving as controls. The assessment of SAE comprised a neuropsychiatric examination, electroencephalography (EEG), magnetic resonance imaging (MRI) and delirium screening methods including the confusion assessment method for the ICU (CAM-ICU) and the intensive care delirium screening checklist (ICDSC). CSF Nf measurements in sepsis patients and longitudinal plasma Nf measurements in all participants were performed on days 1, 3 and 7 after study inclusion. Plasma NfL levels increased in sepsis patients over time (p = 0.0063) and remained stable in patients without sepsis. Plasma NfL values were significantly higher in patients with SAE (p = 0.011), significantly correlated with the severity of SAE represented by ICDSC values (R = 0.534, p = 0.022) and correlated with a poorer functional outcome after 100 days (R = -0.535, p = 0.0003). High levels of CSF Nf were measured in SAE patients. CSF NfL levels were higher in non-survivors (p = 0.012) compared with survivors and correlated with days until death (R = -0.932, p