All authors: Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Crit Care Med. 2019 Jul;47(7):e538-e546. doi: 10.1097/CCM.0000000000003764.
After return of spontaneous circulation, patients who experienced out-of-hospital cardiac arrest present an impaired innate immune response that resembles sepsis. Presepsin, a new biomarker for sepsis, has not been studied in out-of-hospital cardiac arrest patients. This study explored the role of presepsin in evaluating the prognosis and early innate immune alteration of out-of-hospital cardiac arrest patients after return of spontaneous circulation by observing presepsin levels, CD14, and human leukocyte antigen-DR expression on monocytes.
Retrospective analysis.
The emergency department of an urban university tertiary hospital.
One hundred sixty-five out-of-hospital cardiac arrest patients with return of spontaneous circulation more than 12 hours, and 100 healthy individuals.
None.
Plasma presepsin and procalcitonin levels were tested after resuscitation (day 0) and on days 1 and 3 after return of spontaneous circulation. Presepsin levels were higher in out-of-hospital cardiac arrest patients than in healthy individuals. In the first 3 days, presepsin and procalcitonin levels were persistently lower in 28-day survivors and patients with favorable neurologic outcome patients than in 28-day nonsurvivors and patients with unfavorable neurologic outcome. On days 0, 1, and 3, different cut-off values of presepsin showed prognostic value for 28-day mortality and favorable neurologic outcomes similar to procalcitonin. CD14 and human leukocyte antigen-DR expression on monocytes were analyzed by flow cytometry. Compared with controls, CD14 expression in out-of-hospital cardiac arrest patients increased on day 1 and began to decrease on day 3, whereas human leukocyte antigen-DR+ monocyte percentages decreased on days 1 and 3. Presepsin and procalcitonin had a low positive correlation with CD14 expression and a strong negative correlation with human leukocyte antigen-DR+ monocyte percentages on day 1.
Plasma presepsin concentrations are independent prognostic factors for out-of-hospital cardiac arrest patients after return of spontaneous circulation and are correlated with abnormal CD14 and human leukocyte antigen-DR expression on monocytes. Monitoring presepsin levels may be helpful for evaluating the prognosis and impaired innate immune response in the early period after return of spontaneous circulation.
自主循环恢复后，经历院外心脏骤停的患者会出现类似于脓毒症的先天免疫反应受损。作为一种新的脓毒症生物标志物，促炎因子（s）尚未在院外心脏骤停患者中进行研究。本研究通过观察促炎因子（s）水平、单核细胞上 CD14 和人类白细胞抗原-DR 的表达，探讨了促炎因子（s）在评估自主循环恢复后院外心脏骤停患者预后和早期先天免疫改变中的作用。
回顾性分析。
城市大学三级医院的急诊科。
165 例自主循环恢复超过 12 小时的院外心脏骤停患者和 100 名健康个体。
无。
复苏后（第 0 天）和自主循环恢复后第 1 天和第 3 天检测血浆促炎因子（s）和降钙素原水平。院外心脏骤停患者的促炎因子（s）水平高于健康个体。在最初的 3 天中，28 天幸存者和神经功能良好的患者的促炎因子（s）和降钙素原水平持续低于 28 天非幸存者和神经功能不良的患者。在第 0 天、第 1 天和第 3 天，不同临界值的促炎因子（s）对 28 天死亡率和神经功能结局有预后价值，与降钙素原相似。通过流式细胞术分析单核细胞上的 CD14 和人类白细胞抗原-DR 表达。与对照组相比，院外心脏骤停患者的 CD14 表达在第 1 天增加，并在第 3 天开始下降，而人类白细胞抗原-DR+单核细胞百分比在第 1 天和第 3 天下降。第 1 天，促炎因子（s）和降钙素原与 CD14 表达呈低度正相关，与人类白细胞抗原-DR+单核细胞百分比呈强负相关。
自主循环恢复后，血浆促炎因子（s）浓度是院外心脏骤停患者的独立预后因素，与单核细胞上异常的 CD14 和人类白细胞抗原-DR 表达相关。监测促炎因子（s）水平可能有助于评估自主循环恢复后早期的预后和先天免疫反应受损。
