Elevated Serum Glial Fibrillary Acidic Protein (GFAP) is Associated with Poor Functional Outcome After Cardiopulmonary Resuscitation
Elevated Serum Glial Fibrillary Acidic Protein (GFAP) is Associated with Poor Functional Outcome After Cardiopulmonary Resuscitation
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DOI：
10.1007/s12028-016-0371-6
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发表时间：
2017-08-01
影响因子：
3.5
通讯作者：
Foerch, Christian
中科院分区：
文献类型：
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作者：
Helwig, Kirsten;Seeger, Florian;Foerch, Christian
背景心肺复苏（CPR）后患者的神经预后难以评估。GFAP是在细胞死亡的情况下释放到血流中的星形胶质细胞中间丝蛋白。我们进行了一项前瞻性研究，旨在比较复苏后GFAP的预测潜力，更广泛使用的生物标志物神经元特异性烯醇化酶（NSE）。方法100例患者包括在48小时（耐受时间+/- 12小时）后心脏骤停。研究入选后立即采集血清样本。免疫组化法测定血清GFAP和NSE水平。主要结局是4周时的改良格拉斯哥结局量表。结果预后不良（n = 61）和预后良好（n = 39）患者的中位GFAP水平分别为0.03 μ g/L（四分位距0.01-0.07 μ g/L）和0.02 μ g/L（0.01-0.03 μ g/L; p = 0.014）。GFA预测功能预后不良的敏感性为60.7%，特异性为66.7%。所有GFAP水平> 0.08 μ g/L的患者的功能结局均较差。NSE预测预后不良的敏感性为44.3%，特异性为100.0%。多元回归分析显示GFAP、NSE和Karnofsky指数是心肺复苏后预后的独立预测因子。在所有病例中，GFAP水平高于0.08 μ g/L与不良结局相关，并且具有强烈升高值（> 3 μ g/L）的患者在脑成像中始终具有严重的脑损伤。这两种生物标志物独立地有助于CPR后的结果预测。
Background The neurological prognosis of patients after cardiopulmonary resuscitation (CPR) is difficult to assess. GFAP is an astrocytic intermediate filament protein released into bloodstream in case of cell death. We performed a prospective study aiming to compare the predictive potential of GFAP after resuscitation to the more widely used biomarker neuron-specific enolase (NSE).Methods One hundred patients were included at 48 h (tolerance interval +/- 12 h) after cardiac arrest. A serum sample was collected immediately after study inclusion. We determined serum levels of GFAP and NSE by means of immunoassays. Primary outcome was the modified Glasgow outcome scale at 4 weeks. Values below four were considered as a poor functional outcome.Results Median GFAP levels in poor outcome (n = 61) and good outcome (n = 39) patients were 0.03 mu g/L (interquartile range 0.01-0.07 mu g/L) and 0.02 mu g/L (0.01-0.03 mu g/L; p = 0.014), respectively. GFAPrevealed a sensitivity of 60.7% and a specificity of 66.7% to predict a poor functional outcome. All patients having a GFAP level > 0.08 mu g/L had a poor functional outcome. For NSE, sensitivity was 44.3% and specificity was 100.0% for predicting a poor outcome. Multivariate regression analysis revealed GFAP, NSE, and the Karnofsky index to be independent predictors of outcome.Conclusions The release patterns of GFAP and NSE after CPR show differences. GFAP levels above 0.08 mu g/L were associated with a poor outcome in all cases, and patients with strongly elevated values (> 3 mu g/L) consistently had severe brain damage on brain imaging. Both biomarkers independently contribute to outcome prediction after CPR.