心脏停搏幸存者接受目标温度管理与血脑屏障破坏程度的相关性与神经预后的关系。
The Association Between Neurological Prognosis and the Degree of Blood-Brain Barrier Disruption in Cardiac Arrest Survivors Who Underwent Target Temperature Management.
机构信息
Department of Emergency Medicine, Chungnam National University Hospital, Daejoen, Republic of Korea.
Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
出版信息
Neurocrit Care. 2021 Dec;35(3):815-824. doi: 10.1007/s12028-021-01241-0. Epub 2021 Jun 16.
BACKGROUND
This study aimed to compare day-specific associations of blood-brain barrier (BBB) disruption with neurological outcome in survivors of out-of-hospital cardiac arrest (OHCA) treated with target temperature management (TTM) and lumbar drainage.
METHODS
This retrospective single-center study included 68 survivors of OHCA who underwent TTM between April 2018 and December 2019. The albumin quotient (Q) was calculated as Q = albumin/albumin immediately (day 1) and 24 (day 2), 48 (day 3), and 72 h (day 4) after the return of spontaneous circulation. The degree of BBB disruption was weighted using the following scoring system: Q value of 0.007 or less (normal), Q value greater than 0.007-0.01 (mild), Q value greater than 0.01-0.02 (moderate), and Q value greater than 0.02 (severe). Points were assigned as follows: 0 (normal), 1 (mild), 4 (moderate), and 9 (severe). Neurological outcome was determined at 6 months after the return of spontaneous circulation, as well as cerebral performance category (CPC), dichotomized as good (CPC score 1-2) and poor (CPC score 3-5) outcome.
RESULTS
We enrolled 68 patients (48 men, 71%); 37 (54%) patients had a poor neurological outcome. The distributions of poor versus good outcomes at 6 months in patients with moderate and severe BBB disruption were 19 of 22 (80%) vs. 18 of 46 (50%) on day 1, 31 of 37 (79%) vs. 6 of 31 (32%) on day 2, 32 of 37 (81%) vs. 5 of 31 (30%) on day 3, and 32 of 39 (85%) vs. 5 of 29 (30%) on day 4 (P < 0.001), respectively. Using receiver operating characteristic analyses, optimal cutoff values (sensitivity, specificity) of Q levels for the prediction of neurological outcome were as follows: day 1, greater than 0.009 (56.8%, 87.1%); day 2, greater than 0.012 (81.1%, 87.1%); day 3, greater than 0.013 (83.8%, 87.1%); day 4, greater than 0.013 (86.5%, 87.1%); the sum of all time points, greater than 0.039 (89.5%, 79.4%); and scoring system, greater than 9 (91.9%, 87.1%).
CONCLUSIONS
In this proof of concept study, Q was associated with poor neurological outcome in survivors of OHCA treated with TTM with no contraindication to lumbar drainage. A large multicenter prospective study is needed to validate the utility of BBB disruption as a prognosticator of neurological outcome.
背景
本研究旨在比较目标温度管理（TTM）联合腰椎引流治疗院外心脏骤停（OHCA）幸存者中，不同时间点血脑屏障（BBB）破坏与神经结局的相关性。
方法
本回顾性单中心研究纳入了 2018 年 4 月至 2019 年 12 月期间接受 TTM 的 68 例 OHCA 幸存者。白蛋白商（Q）的计算方法为：白蛋白/白蛋白即刻（第 1 天）和复流后 24（第 2 天）、48（第 3 天）和 72 小时（第 4 天）。BBB 破坏程度采用以下评分系统加权：Q 值为 0.007 或以下（正常）、Q 值为 0.007-0.01（轻度）、Q 值为 0.01-0.02（中度）和 Q 值大于 0.02（重度）。赋值如下：0（正常）、1（轻度）、4（中度）和 9（重度）。神经结局在复流后 6 个月时，以及脑功能状态分类（CPC）进行评估，分为良好（CPC 评分 1-2）和不良（CPC 评分 3-5）结局。
结果
共纳入 68 例患者（48 例男性，71%）；37 例（54%）患者存在不良神经结局。在中重度 BBB 破坏患者中，6 个月时不良与良好结局的分布分别为第 1 天为 22 例中的 19 例（80%）比 46 例中的 18 例（50%），第 2 天为 37 例中的 31 例（79%）比 31 例中的 6 例（32%），第 3 天为 37 例中的 32 例（81%）比 31 例中的 5 例（30%），第 4 天为 39 例中的 32 例（85%）比 29 例中的 5 例（30%）（P < 0.001）。使用受试者工作特征分析，Q 值预测神经结局的最佳截断值（敏感性、特异性）如下：第 1 天，大于 0.009（56.8%，87.1%）；第 2 天，大于 0.012（81.1%，87.1%）；第 3 天，大于 0.013（83.8%，87.1%）；第 4 天，大于 0.013（86.5%，87.1%）；所有时间点的总和，大于 0.039（89.5%，79.4%）；评分系统，大于 9（91.9%，87.1%）。
结论
在本概念验证研究中，Q 与 TTM 联合无腰椎引流禁忌证治疗的 OHCA 幸存者不良神经结局相关。需要进行大型多中心前瞻性研究，以验证 BBB 破坏作为神经结局预测因子的效用。
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