Shiba Daiki, Hifumi Toru, Watanabe Yu, Shimizu Masato, Isokawa Shutaro, Toya Nozomi, Iwasaki Tsutomu, Otani Norio, Ishimatsu Shinichi
Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan.
Acute Med Surg. 2020 Dec 10;7(1):e610. doi: 10.1002/ams2.610. eCollection 2020 Jan-Dec.
Early onset pneumonia (EOP) in patients with cardiac arrest treated with targeted temperature management is a recently debated issue. We assessed the association between C-reactive protein (CRP) levels and development of EOP in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR).
We reviewed the data of all patients admitted to our hospital after out-of-hospital cardiac arrest treated with ECPR between April 2006 and April 2019 who survived for at least 48 h. We collected demographic data, cardiac arrest characteristics, prophylactic antibiotic use, and neurologic outcomes. Diagnosis of EOP was made based on clinical, radiological, and microbiological criteria. The primary endpoint was the association between the incidence of EOP and CRP levels from day 1 to day 4. A total of 55 patients were included, of which 20 developed EOP. CRP levels on days 3 and 4 were significantly elevated in patients who developed EOP (13.1 [11.8-21.1] mg/dL versus 11.6 [7.4-15.2] mg/dL, P = 0.005; and 19.0 [16.9-27.1] mg/dL versus 14.7 [7.4-21.2] mg/dL, P = 0.019, respectively). In the multivariable logistic regression model, the CRP level on day 3 was significantly associated with the development of EOP (odds ratio 1.22; 95% confidence interval 1.06-1.41; P = 0.001).
Increased inflammation in acute phase was associated with development of EOP in patients treated with ECPR.
接受目标温度管理的心脏骤停患者发生早发性肺炎（EOP）是最近备受争议的问题。我们评估了接受体外心肺复苏（ECPR）治疗的患者中C反应蛋白（CRP）水平与EOP发生之间的关联。
我们回顾了2006年4月至2019年4月期间因院外心脏骤停接受ECPR治疗后至少存活48小时并入住我院的所有患者的数据。我们收集了人口统计学数据、心脏骤停特征、预防性抗生素使用情况和神经学转归。EOP的诊断基于临床、影像学和微生物学标准。主要终点是第1天至第4天EOP发病率与CRP水平之间的关联。共纳入55例患者，其中20例发生EOP。发生EOP的患者第3天和第4天的CRP水平显著升高（分别为13.1[11.8 - 21.1]mg/dL对11.6[7.4 - 15.2]mg/dL，P = 0.005；以及19.0[16.9 - 27.1]mg/dL对14.7[7.4 - 21.2]mg/dL，P = 0.019）。在多变量逻辑回归模型中，第3天的CRP水平与EOP的发生显著相关（比值比1.22；95%置信区间1.06 - 1.41；P = 0.001）。
急性期炎症增加与接受ECPR治疗的患者发生EOP有关。
