神经丝轻链作为心搏骤停后结局的预测指标：COMACARE 试验的事后分析。
Neurofilament light as an outcome predictor after cardiac arrest: a post hoc analysis of the COMACARE trial.
机构信息
Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland.
Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
出版信息
Intensive Care Med. 2021 Jan;47(1):39-48. doi: 10.1007/s00134-020-06218-9. Epub 2020 Aug 27.
PURPOSE
Neurofilament light (NfL) is a biomarker reflecting neurodegeneration and acute neuronal injury, and an increase is found following hypoxic brain damage. We assessed the ability of plasma NfL to predict outcome in comatose patients after out-of-hospital cardiac arrest (OHCA). We also compared plasma NfL concentrations between patients treated with two different targets of arterial carbon dioxide tension (PaCO), arterial oxygen tension (PaO), and mean arterial pressure (MAP).
METHODS
We measured NfL concentrations in plasma obtained at intensive care unit admission and at 24, 48, and 72 h after OHCA. We assessed neurological outcome at 6 months and defined a good outcome as Cerebral Performance Category (CPC) 1-2 and poor outcome as CPC 3-5.
RESULTS
Six-month outcome was good in 73/112 (65%) patients. Forty-eight hours after OHCA, the median NfL concentration was 19 (interquartile range [IQR] 11-31) pg/ml in patients with good outcome and 2343 (587-5829) pg/ml in those with poor outcome, p < 0.001. NfL predicted poor outcome with an area under the receiver operating characteristic curve (AUROC) of 0.98 (95% confidence interval [CI] 0.97-1.00) at 24 h, 0.98 (0.97-1.00) at 48 h, and 0.98 (0.95-1.00) at 72 h. NfL concentrations were lower in the higher MAP (80-100 mmHg) group than in the lower MAP (65-75 mmHg) group at 48 h (median, 23 vs. 43 pg/ml, p = 0.04). PaCO and PaO targets did not associate with NfL levels.
CONCLUSIONS
NfL demonstrated excellent prognostic accuracy after OHCA. Higher MAP was associated with lower NfL concentrations.
目的
神经丝轻链（NfL）是一种反映神经退行性变和急性神经元损伤的生物标志物，在缺氧性脑损伤后会增加。我们评估了昏迷的院外心脏骤停（OHCA）患者血浆 NfL 预测预后的能力。我们还比较了接受两种不同动脉二氧化碳分压（PaCO）、动脉氧分压（PaO）和平均动脉压（MAP）目标治疗的患者之间的血浆 NfL 浓度。
方法
我们在 ICU 入院时和 OHCA 后 24、48 和 72 小时测量了血浆中 NfL 的浓度。我们在 6 个月时评估了神经学结局，并将良好结局定义为脑功能预后分类（CPC）1-2，不良结局定义为 CPC 3-5。
结果
6 个月时，73/112（65%）患者的结局良好。OHCA 后 48 小时，良好结局患者的中位 NfL 浓度为 19（四分位距[IQR] 11-31）pg/ml，不良结局患者为 2343（587-5829）pg/ml，p<0.001。NfL 在 24 小时时预测不良结局的曲线下面积（AUROC）为 0.98（95%置信区间[CI] 0.97-1.00），在 48 小时时为 0.98（0.97-1.00），在 72 小时时为 0.98（0.95-1.00）。在 48 小时时，MAP 较高（80-100mmHg）组的 NfL 浓度低于 MAP 较低（65-75mmHg）组（中位数，23 与 43pg/ml，p=0.04）。PaCO 和 PaO 目标与 NfL 水平无关。
结论
NfL 在 OHCA 后显示出优异的预后准确性。较高的 MAP 与较低的 NfL 浓度相关。
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