Reuter Jean, Peoc'h Katell, Bouadma Lila, Ruckly Stéphane, Chicha-Cattoir Valérie, Faille Dorothée, Bourrienne Marie-Charlotte, Dupuis Claire, Magalhaes Eric, Tanaka Sébastien, Vinclair Camille, de Montmollin Etienne, Mazighi Mikael, Para Marylou, Braham Wael, Pisani Angelo, Ajzenberg Nadine, Timsit Jean-François, Sonneville Romain
Université de Paris, INSERM UMR1148, Team 6, Paris, France.
Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, Paris, France.
Crit Care Explor. 2020 Oct 15;2(10):e0239. doi: 10.1097/CCE.0000000000000239. eCollection 2020 Oct.
We aimed to determine if elevations in serum neuron-specific enolase are associated with brain injury and outcomes in adults who require venoarterial extracorporeal membrane oxygenation.
Prospective observational study.
Two ICUs of a university hospital, Paris, France.
Consecutive adult patients treated with venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock or in-hospital refractory cardiac arrest.
None.
Serum sampled 1, 3, and 7 days after venoarterial extracorporeal membrane oxygenation cannulation was stored at -80°C and neuron-specific enolase concentrations were measured in batches at the end of the study. The association between neuron-specific enolase concentrations and outcomes (28-d mortality and poor outcome, defined by a score of 4-6 on the modified Rankin scale at 90 d) were explored by multivariable logistic regression, with neuron-specific enolase concentrations dichotomized according to median values. One-hundred three patients were included, of whom 26 (25%) received preextracorporeal membrane oxygenation cardiopulmonary resuscitation. Median (interquartile range) day-1, day-3, and day-7 neuron-specific enolase serum concentrations were 37 μg/L (26-51 μg/L), 25 μg/L (19-37) μg/L, and 22 μg/L (17-31 μg/L). After adjustment for Simplified Acute Physiology Score II, preextracorporeal membrane oxygenation cardiopulmonary resuscitation, and Sepsis Organ Failure Assessment score at time of cannulation, a day-3 neuron-specific enolase greater than 25 μg/L remained independently associated with 28-day mortality (adjusted odds ratio, 4.98; 95% CI, 1.86-13.32) and poor outcome at 90 days (adjusted odds ratio, 4.63; 95% CI, 1.81-11.84). A day-3 neuron-specific enolase threshold greater than 80 μg/L had a 100% specificity for prediction of both mortality (95% CI, 92-100%) and poor functional outcome (95% CI, 89-100%). In a subset of patients who underwent brain CT, neuron-specific enolase concentrations were significantly higher in patients diagnosed with stroke, as compared with those without stroke.
In adult patients under venoarterial extracorporeal membrane oxygenation, day-3 serum neuron-specific enolase concentrations are independently associated with short-term mortality and poor functional outcomes. These findings deserve validation in a multicenter setting.
我们旨在确定血清神经元特异性烯醇化酶升高是否与需要静脉-动脉体外膜肺氧合的成人脑损伤及预后相关。
前瞻性观察性研究。
法国巴黎一所大学医院的两个重症监护病房。
因难治性心源性休克或院内难治性心脏骤停接受静脉-动脉体外膜肺氧合治疗的成年连续患者。
无。
在静脉-动脉体外膜肺氧合插管后第1、3和7天采集的血清储存于-80°C，在研究结束时成批测量神经元特异性烯醇化酶浓度。通过多变量逻辑回归探讨神经元特异性烯醇化酶浓度与预后（28天死亡率和不良预后，定义为90天时改良Rankin量表评分为4 - 6分）之间的关联，将神经元特异性烯醇化酶浓度根据中位数进行二分法分类。纳入103例患者，其中26例（25%）在体外膜肺氧合前接受了心肺复苏。第1天、第3天和第7天神经元特异性烯醇化酶血清浓度的中位数（四分位间距）分别为37μg/L（26 - 51μg/L）、25μg/L（19 - 37μg/L）和22μg/L（17 - 31μg/L）。在调整简化急性生理学评分II、体外膜肺氧合前心肺复苏以及插管时的脓毒症器官功能衰竭评估评分后，第3天神经元特异性烯醇化酶大于25μg/L仍与28天死亡率（调整后的优势比，4.98；95%CI，1.86 - 13.32）和90天时的不良预后（调整后的优势比，4.63；95%CI，1.81 - 11.84）独立相关。第3天神经元特异性烯醇化酶阈值大于80μg/L对死亡率（95%CI，92 - 100%）和功能不良预后（95%CI，89 - 100%）的预测具有100%的特异性。在接受脑部CT检查的患者亚组中，与未发生卒中的患者相比，诊断为卒中的患者神经元特异性烯醇化酶浓度显著更高。
在接受静脉-动脉体外膜肺氧合的成年患者中，第3天血清神经元特异性烯醇化酶浓度与短期死亡率和功能不良预后独立相关。这些发现值得在多中心环境中进行验证。
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