伴有神经元特异性烯醇化酶的连续弥散性血管内凝血评分可预测心脏骤停的死亡率——一项初步研究
Serial disseminated intravascular coagulation score with neuron specific enolase predicts the mortality of cardiac arrest-a pilot study.
作者信息
Zhai Qiangrong, Feng Lu, Zhang Hua, Wu Meng, Wang Daidai, Ge Hongxia, Li Shu, Du Langfang, Zheng Kang, Li Hui, Liu Shaoyu, Zhao Jingjing, Huai Wei, Ma Qingbian
机构信息
Department of Emergency, Peking University Third Hospital, Beijing, China.
The Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, China.
出版信息
J Thorac Dis. 2020 Jul;12(7):3573-3581. doi: 10.21037/jtd-20-580.
BACKGROUND
Prognosis in cardiac arrest (CA) patients has been challenging. We sought to investigate prognostic value combining serial disseminated intravascular coagulation (DIC) score and neuron-specific enolase (NSE) in out-of-hospital cardiac arrest (OHCA) patients.
METHODS
Sixty-one consecutive patients successfully resuscitated after CA were included in the analysis. DIC score and NSE levels were serially analyzed after return of spontaneous circulation (ROSC). The outcome measure was death before hospital discharge. Prognostication performance was assessed as the area under the receiver-operating characteristics curve (AUC). Hosmer-Lemeshow test was used for internal validation of predictive models. Calibration curves were drawn to visualize the results of tests.
RESULTS
The NSE levels continued to increase in the first 72 h in non-survivors. In survivors, the NSE levels decreased after 48 h. Both DIC score at 48 h and NSE level at 48 h were good predictors of outcome. The AUC for predictive mortality in OHCA patients was 0.869 (95% CI, 0.781-0.956) for DIC score at 48 h combining NSE at 24 h, 0.878 (95% CI, 0.791-0.965) for DIC score at 48 h combining NSE at 48 h and 0.882 (95% CI, 0.792-0.972) for DIC score at 48 h combining NSE at 72 h, respectively. Significance of Hosmer-Lemeshow test was 0.488, 0.324, 0.011 for each combination.
CONCLUSIONS
Serial DIC score combined with measurement of NSE levels is a useful and accessible tool for prognostication following OHCA.
背景
心脏骤停（CA）患者的预后一直具有挑战性。我们试图研究在院外心脏骤停（OHCA）患者中，将连续的弥散性血管内凝血（DIC）评分与神经元特异性烯醇化酶（NSE）相结合的预后价值。
方法
分析61例心脏骤停后成功复苏的连续患者。自主循环恢复（ROSC）后对DIC评分和NSE水平进行连续分析。结局指标为出院前死亡。将预测性能评估为受试者操作特征曲线（AUC）下的面积。使用Hosmer-Lemeshow检验对预测模型进行内部验证。绘制校准曲线以直观显示测试结果。
结果
非幸存者的NSE水平在最初72小时内持续升高。在幸存者中，NSE水平在48小时后下降。48小时时的DIC评分和48小时时的NSE水平都是结局的良好预测指标。对于OHCA患者，48小时时的DIC评分结合24小时时的NSE预测死亡率的AUC为0.869（95%CI，0.781-0.956），48小时时的DIC评分结合48小时时的NSE为0.878（95%CI，0.791-0.965），48小时时的DIC评分结合72小时时的NSE为0.882（95%CI，0.792-0.972）。每种组合的Hosmer-Lemeshow检验的显著性分别为0.488、0.324、0.011。
结论
连续的DIC评分与NSE水平测量相结合是OHCA后预后评估的一种有用且可获得的工具。
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