Jang Jae Ho, Park Won Bin, Lim Yong Su, Choi Jea Yeon, Cho Jin Seong, Woo Jae-Hyug, Choi Woo Sung, Yang Hyuk Jun, Hyun Sung Youl
Department of Emergency Medicine, Gachon University Gil Medical Center.
Department of Emergency Medicine.
Medicine (Baltimore). 2019 Feb;98(6):e14496. doi: 10.1097/MD.0000000000014496.
This study aimed to determine whether the combination of procalcitonin (PCT) and S100B improves prognostic performance compared to either alone in cardiac arrest (CA) patients treated with targeted temperature management (TTM).We performed a prospective cohort study of CA patients treated with TTM. PCT and S100B levels were obtained at 0, 24, 48, and 72 hours after return of spontaneous circulation. The prognostic performance was analyzed using each marker and the combination of the 2 markers for predicting poor neurological outcome at 3 months and mortality at 14 days and 3 months.A total of 97 patients were enrolled, of which 67 (69.1%) had poor neurological outcome. S100B showed a better prognostic performance (area under the curve [AUC], 0.934; sensitivity, 77.6%; and specificity, 100%) than PCT (AUC, 0.861; sensitivity, 70.2%; and specificity, 83.3%) with the highest prognostic value at 24 hours. The combination of 24-hour PCT and S100B values (S100B ≥0.2 μg/L or PCT ≥6.6 ng/mL) improved sensitivity (85.07%) compared with S100B alone. In multivariate analysis, PCT was associated with mortality at 14 days (odds ratio [OR]: 1.064, 95% confidence interval [CI]: 1.014-1.118), whereas S100B was associated with neurological outcomes at 3 months (OR: 9.849, 95% CI: 2.089-46.431).The combination of PCT and S100B improved prognostic performance compared to the use of either biomarker alone in CA patient treated with TTM. Further studies that will identify the optimal cutoff values for these biomarkers must be conducted.
本研究旨在确定与单独使用相比，降钙素原（PCT）和S100B联合使用是否能改善接受目标温度管理（TTM）的心脏骤停（CA）患者的预后。我们对接受TTM治疗的CA患者进行了一项前瞻性队列研究。在自主循环恢复后的0、24、48和72小时获取PCT和S100B水平。使用每个标志物以及这两个标志物的组合分析其对3个月时不良神经结局以及14天和3个月时死亡率的预测预后性能。总共纳入了97例患者，其中67例（69.1%）有不良神经结局。S100B显示出比PCT更好的预后性能（曲线下面积[AUC]为0.934；敏感性为77.6%；特异性为100%），而PCT的AUC为0.861；敏感性为70.2%；特异性为83.3%，在24小时时具有最高的预后价值。24小时PCT和S100B值的组合（S100B≥0.2μg/L或PCT≥6.6ng/mL）与单独使用S100B相比提高了敏感性（85.07%）。在多变量分析中，PCT与14天死亡率相关（比值比[OR]：1.064，95%置信区间[CI]：1.014 - 1.118），而S100B与3个月时的神经结局相关（OR：9.849，95%CI：2.089 - 46.431）。与单独使用任何一种生物标志物相比，PCT和S100B的联合使用改善了接受TTM治疗的CA患者的预后性能。必须开展进一步的研究来确定这些生物标志物的最佳临界值。
