Kaneko Tadashi, Fujita Motoki, Ogino Yasuaki, Yamamoto Takahiro, Tsuruta Ryosuke, Kasaoka Shunji
Emergency and General Medicine, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Japan.
BMC Cardiovasc Disord. 2017 May 8;17(1):111. doi: 10.1186/s12872-017-0545-y.
Serum neutrophil gelatinase-associated lipocalin (NGAL) is a well-known biomarker of acute kidney injury. Serum NGAL was recently proposed as a potential predictor of mortality in post cardiac arrest syndrome (PCAS) patients following out-of-hospital cardiac arrest (OHCA). However, the potential predictive value of NGAL for neurological outcomes is unknown. Therefore, we assessed the potential predictive value of NGAL for neurological outcomes after OHCA. We also compared its predictive value with that of neuron-specific enolase (NSE) as an established biomarker.
Blood samples were prospectively collected from 43 PCAS patients following OHCA. Serum NGAL was measured on days 1 and 2, and NSE was measured on day 2. These biomarkers were compared between patients with favourable (cerebral performance category [CPC] 1-2) and unfavourable (CPC 3-5) outcomes. Receiver operating characteristic (ROC) curve analysis was performed.
Serum NGAL and NSE on day 2 (both P < 0.001), but not NGAL on day 1 (P = 0.609), were significantly different between the favourable and unfavourable groups. In ROC curve analysis, the sensitivity and specificity were 83% and 85%, respectively, for NGAL (day 2) at a cutoff value of 204 ng/mL and were 84% and 100% for NSE (day 2) at a cutoff value of 28.8 ng/mL. The area under the ROC curve of NGAL (day 2) was equivalent to that of NSE (day 2) (0.830 vs. 0.918). Additionally, the area under the ROC curve in subgroup of estimated glomerular filtration rate (eGFR) > 20 mL/min/1.73 m (n = 38, 0.978 vs. 0.923) showed the potential of NGAL predictability.
Serum NGAL might predict the neurological outcomes of PCAS patients, and its predictive value was equivalent to that of NSE.
血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是急性肾损伤的一种知名生物标志物。最近，血清NGAL被提议作为院外心脏骤停（OHCA）后心脏骤停综合征（PCAS）患者死亡率的潜在预测指标。然而，NGAL对神经功能结局的潜在预测价值尚不清楚。因此，我们评估了NGAL对OHCA后神经功能结局的潜在预测价值。我们还将其预测价值与已确立的生物标志物神经元特异性烯醇化酶（NSE）的预测价值进行了比较。
前瞻性地收集了43例OHCA后PCAS患者的血样。在第1天和第2天测量血清NGAL，在第2天测量NSE。比较了预后良好（脑功能分类[CPC]1-2）和预后不良（CPC 3-5）患者之间的这些生物标志物。进行了受试者工作特征（ROC）曲线分析。
第2天的血清NGAL和NSE（均P<0.001），但第1天的NGAL（P=0.609）在预后良好组和预后不良组之间有显著差异。在ROC曲线分析中，NGAL（第2天）在临界值为204 ng/mL时的敏感性和特异性分别为83%和85%，NSE（第2天）在临界值为28.8 ng/mL时的敏感性和特异性分别为84%和100%。NGAL（第2天）的ROC曲线下面积与NSE（第2天）的相等（0.830对0.918）。此外，估计肾小球滤过率（eGFR）>20 mL/min/1.73 m²的亚组（n=38，0.978对0.923）的ROC曲线下面积显示了NGAL的预测潜力。
血清NGAL可能预测PCAS患者的神经功能结局，其预测价值与NSE相当。
