Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea.
Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea.
Am J Emerg Med. 2018 Apr;36(4):660-664. doi: 10.1016/j.ajem.2017.12.013. Epub 2017 Dec 7.
Neutrophil gelatinase-associated lipocalin (NGAL) is secreted by various tissues in pathologic states. Previous studies reported that post-cardiac arrest serum NGAL levels correlate with short-term neurologic outcomes and survival. The aim of this study was to examine the associations between NGAL levels post-cardiac arrest and long-term outcomes and survival.
This prospective observational study and retrospective review included adult out-of-hospital cardiac arrest survivors who were treated by hypothermia-targeted temperature management. Serum NGAL was assessed at 0, 24, 48, and 72h after return of spontaneous circulation. The primary outcome was poor outcome at six months after cardiac arrest, defined as cerebral performance category score of 3-5. The secondary outcome was six-month mortality.
In total, 76 patients were analyzed. The patients with poor outcomes showed significantly higher NGAL levels at 24, 48 and 72h after cardiac arrest than the patients with good outcomes. Long-term survival rates were significantly lower in the high-NGAL group than in the low-NGAL group at each time point. Subgroup analysis of patients who survived 72h showed that only serum NGAL 72h after cardiac arrest had prognostic value for long-term outcomes (area under the receiver operating characteristic curve=0.72; p=0.02).
Post-cardiac arrest serum NGAL is associated with long-term outcomes and survival; particularly, three days post-cardiac arrest is the optimal time point for predicting long-term outcomes. However, the predictive power of NGAL is unsatisfactory, and it should be regarded as an additional prognostic modality.
中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在病理状态下由各种组织分泌。先前的研究报告称，心脏骤停后血清 NGAL 水平与短期神经预后和存活率相关。本研究旨在探讨心脏骤停后 NGAL 水平与长期预后和存活率之间的关系。
这项前瞻性观察性研究和回顾性分析纳入了接受低温目标体温管理治疗的院外心脏骤停幸存者。在自主循环恢复后 0、24、48 和 72 小时评估血清 NGAL。主要结局为心脏骤停后 6 个月预后不良，定义为脑功能预后评分 3-5。次要结局为 6 个月死亡率。
共分析了 76 例患者。预后不良的患者在心脏骤停后 24、48 和 72 小时的 NGAL 水平明显高于预后良好的患者。在每个时间点，高 NGAL 组的长期生存率明显低于低 NGAL 组。对存活 72 小时的患者进行亚组分析表明，只有心脏骤停后 72 小时的血清 NGAL 对长期预后有预测价值（受试者工作特征曲线下面积=0.72；p=0.02）。
心脏骤停后血清 NGAL 与长期预后和存活率相关；特别是，心脏骤停后 3 天是预测长期预后的最佳时间点。然而，NGAL 的预测能力并不令人满意，应将其视为一种附加的预后模式。
