Choi Seungwoon, Park Kyunam, Ryu Seokyong, Kang Taekyung, Kim Hyejin, Cho Sukjin, Oh Sungchan
Department of Emergency Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea.
Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Emerg Med J. 2016 Oct;33(10):690-5. doi: 10.1136/emermed-2015-205423. Epub 2016 Jun 10.
With the introduction of therapeutic hypothermia (TH), the prediction of neurological outcomes in cardiac arrest (CA) survivors is challenging. Early, accurate determination of prognosis by emergency physicians is important to avoid unnecessarily prolonged critical care with a likely poor neurological outcome.
This prospective observational study included patients with non-traumatic CA and return of spontaneous circulation (ROSC) between March 2009 and May 2012 at a tertiary academic hospital. Unconscious patients with ROSC were treated with mild TH (32°C-34°C) for 24 hours. Blood samples were collected for S-100B, neuron-specific enolase (NSE), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at 0, 24 and 48 hours post-ROSC. Neurological outcomes were evaluated at hospital discharge and dichotomised as good (cerebral performance category (CPC) 1 or 2) or poor (CPC 3, 4 or 5).
Of the 119 patients (68.1% male, 53±15.6 years old) who underwent TH, 46 patients had a good outcome (38.9%). Poor neurological outcomes were predicted using receiver operating characteristic analyses at cut-off values of 0.12 g/L for S-100B at 24 hours post-ROSC (sensitivity, 95.0%; specificity, 75.6%; area under the curve (AUC) 0.916; 95% CI of AUC: 0.846 to 0.961), 31.03 ng/mL for NSE at 48 hours post-ROSC (sensitivity, 83.9%; specificity, 96.9%; AUC 0.929; 95% CI of AUC: 0.836 to 0.979) and 11.2 mg/dL for CRP at 48 hours post-ROSC (sensitivity, 69.4%; specificity, 75.0%; AUC 0.731; 95% CI of AUC: 0.617 to 0.827). ESR was not significant.
Among the biomarkers, S-100B at 24 hours and NSE at 48 hours post-ROSC were highly predictive of neurological outcomes in patients treated with TH after CA.
随着治疗性低温（TH）的引入，预测心脏骤停（CA）幸存者的神经功能结局具有挑战性。急诊医生尽早、准确地判断预后对于避免对神经功能结局可能较差的患者进行不必要的长时间重症监护很重要。
这项前瞻性观察性研究纳入了2009年3月至2012年5月在一家三级学术医院发生非创伤性CA且恢复自主循环（ROSC）的患者。恢复自主循环的昏迷患者接受轻度低温（32°C - 34°C）治疗24小时。在恢复自主循环后0、24和48小时采集血样检测S-100B、神经元特异性烯醇化酶（NSE）、C反应蛋白（CRP）和红细胞沉降率（ESR）。在出院时评估神经功能结局，并分为良好（脑功能分类（CPC）1或2）或不良（CPC 3、4或5）。
在接受低温治疗的119例患者（男性占68.1%，年龄53±15.6岁）中，46例患者结局良好（38.9%）。通过受试者工作特征分析预测不良神经功能结局，恢复自主循环后24小时S-100B的临界值为0.12 g/L（敏感性95.0%；特异性75.6%；曲线下面积（AUC）0.916；AUC的95%可信区间：0.846至0.961），恢复自主循环后48小时NSE为31.03 ng/mL（敏感性83.9%；特异性96.9%；AUC 0.929；AUC的95%可信区间：0.836至0.979），恢复自主循环后48小时CRP为11.2 mg/dL（敏感性69.4%；特异性75.0%；AUC 0.731；AUC的95%可信区间：0.617至0.827）。红细胞沉降率无显著意义。
在生物标志物中，恢复自主循环后24小时的S-100B和48小时的NSE对心脏骤停后接受低温治疗患者的神经功能结局具有高度预测性。
