血清蛋白 S100 作为院外心脏骤停后目标温度管理在 33°C 和 36°C 时的预后预测因子。
Protein S100 as outcome predictor after out-of-hospital cardiac arrest and targeted temperature management at 33 °C and 36 °C.
机构信息
Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier de Luxembourg, 4, rue Barblé, L-1210, Luxembourg, Luxembourg.
Department of Cardiology, Skåne University Hospital, Lund, Sweden.
出版信息
Crit Care. 2017 Jun 20;21(1):153. doi: 10.1186/s13054-017-1729-7.
BACKGROUND
We aimed to investigate the diagnostic performance of S100 as an outcome predictor after out-of-hospital cardiac arrest (OHCA) and the potential influence of two target temperatures (33 °C and 36 °C) on serum levels of S100.
METHODS
This is a substudy of the Target Temperature Management after Out-of-Hospital Cardiac Arrest (TTM) trial. Serum levels of S100 were measured a posteriori in a core laboratory in samples collected at 24, 48, and 72 h after OHCA. Outcome at 6 months was assessed using the Cerebral Performance Categories Scale (CPC 1-2 = good outcome, CPC 3-5 = poor outcome).
RESULTS
We included 687 patients from 29 sites in Europe. Median S100 values were higher in patients with a poor outcome at 24, 48, and 72 h: 0.19 (IQR 0.10-0.49) versus 0.08 (IQR 0.06-0.11) μg/ml, 0.16 (IQR 0.10-0.44) versus 0.07 (IQR 0.06-0.11) μg/L, and 0.13 (IQR 0.08-0.26) versus 0.06 (IQR 0.05-0.09) μg/L (p < 0.001), respectively. The ability to predict outcome was best at 24 h with an AUC of 0.80 (95% CI 0.77-0.83). S100 values were higher at 24 and 72 h in the 33 °C group than in the 36 °C group (0.12 [0.07-0.22] versus 0.10 [0.07-0.21] μg/L and 0.09 [0.06-0.17] versus 0.08 [0.05-0.10], respectively) (p < 0.02). In multivariable analyses including baseline variables and the allocated target temperature, the addition of S100 improved the AUC from 0.80 to 0.84 (95% CI 0.81-0.87) (p < 0.001), but S100 was not an independent outcome predictor. Adding S100 to the same model including neuron-specific enolase (NSE) did not further improve the AUC.
CONCLUSIONS
The allocated target temperature did not affect S100 to a clinically relevant degree. High S100 values are predictive of poor outcome but do not add value to present prognostication models with or without NSE. S100 measured at 24 h and afterward is of limited value in clinical outcome prediction after OHCA.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT01020916 . Registered on 25 November 2009.
背景
我们旨在研究 S100 在院外心脏骤停（OHCA）后的预后预测中的诊断性能，以及两个目标温度（33°C 和 36°C）对 S100 血清水平的潜在影响。
方法
这是 Target Temperature Management after Out-of-Hospital Cardiac Arrest（TTM）试验的一个亚研究。在 OHCA 后 24、48 和 72 小时采集的样本中，在核心实验室进行了 S100 的后测。6 个月时的预后采用神经功能预后评分（Cerebral Performance Categories Scale，CPC 1-2=良好预后，CPC 3-5=预后不良）进行评估。
结果
我们纳入了欧洲 29 个地点的 687 名患者。24、48 和 72 小时时，预后不良患者的 S100 值更高：0.19（IQR 0.10-0.49）vs 0.08（IQR 0.06-0.11）μg/ml，0.16（IQR 0.10-0.44）vs 0.07（IQR 0.06-0.11）μg/L，0.13（IQR 0.08-0.26）vs 0.06（IQR 0.05-0.09）μg/L（p<0.001）。24 小时时的预测能力最佳，AUC 为 0.80（95%CI 0.77-0.83）。与 36°C 组相比，33°C 组 24 和 72 小时时的 S100 值更高（0.12 [0.07-0.22] vs 0.10 [0.07-0.21] μg/L 和 0.09 [0.06-0.17] vs 0.08 [0.05-0.10]）（p<0.02）。包括基线变量和目标温度在内的多变量分析中，添加 S100 可将 AUC 从 0.80 提高到 0.84（95%CI 0.81-0.87）（p<0.001），但 S100 并不是独立的预后预测因子。将 S100 添加到包括神经元特异性烯醇化酶（NSE）的相同模型中，并不会进一步提高 AUC。
结论
目标温度的设定不会对 S100 产生显著影响。高 S100 值预示预后不良，但无论是否包含 NSE，均无法为目前的预后模型提供更多价值。OHCA 后 24 小时及之后的 S100 值对临床预后预测的价值有限。
临床试验注册号
NCT01020916，于 2009 年 11 月 25 日注册。
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