Helwig Kirsten, Seeger Florian, Hölschermann Hans, Lischke Volker, Gerriets Tibo, Niessner Marion, Foerch Christian
Department of Neurology, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
Department of Cardiology, Goethe University, Frankfurt am Main, Germany.
Neurocrit Care. 2017 Aug;27(1):68-74. doi: 10.1007/s12028-016-0371-6.
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).
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.
Median GFAP levels in poor outcome (n = 61) and good outcome (n = 39) patients were 0.03 μg/L (interquartile range 0.01-0.07 μg/L) and 0.02 μg/L (0.01-0.03 μg/L; p = 0.014), respectively. GFAP revealed 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 µg/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.
The release patterns of GFAP and NSE after CPR show differences. GFAP levels above 0.08 µg/L were associated with a poor outcome in all cases, and patients with strongly elevated values (>3 µg/L) consistently had severe brain damage on brain imaging. Both biomarkers independently contribute to outcome prediction after CPR.
心肺复苏（CPR）后患者的神经学预后难以评估。胶质纤维酸性蛋白（GFAP）是一种在细胞死亡时释放到血液中的星形细胞中间丝蛋白。我们进行了一项前瞻性研究，旨在比较复苏后GFAP与更广泛使用的生物标志物神经元特异性烯醇化酶（NSE）的预测潜力。
纳入100例心脏骤停后48小时（允许区间±12小时）的患者。纳入研究后立即采集血清样本。我们通过免疫测定法测定血清GFAP和NSE水平。主要结局是4周时的改良格拉斯哥结局量表。得分低于4分被认为是功能结局不良。
结局不良（n = 61）和结局良好（n = 39）患者的GFAP中位数水平分别为0.03μg/L（四分位间距0.01 - 0.07μg/L）和0.02μg/L（0.01 - 0.03μg/L；p = 0.014）。GFAP预测功能结局不良的敏感性为60.7%，特异性为66.7%。所有GFAP水平>0.08μg/L的患者功能结局均不良。对于NSE，预测不良结局的敏感性为44.3%，特异性为100.0%。多变量回归分析显示GFAP、NSE和卡诺夫斯基指数是结局的独立预测因素。
CPR后GFAP和NSE的释放模式存在差异。所有病例中，GFAP水平高于0.08μg/L与不良结局相关，且值显著升高（>3μg/L）的患者在脑成像上始终有严重脑损伤。两种生物标志物均独立有助于CPR后的结局预测。
