Departments of Critical Care Medicine, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Departments of Critical Care Medicine, Pittsburgh, PA, USA; Pediatrics, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Resuscitation. 2022 Mar;172:173-180. doi: 10.1016/j.resuscitation.2021.11.016. Epub 2021 Nov 22.
Fibroblast Growth Factor 21 (FGF21) and Growth Differentiation Factor-15 (GDF-15) are putative neuroprotective cold stress hormones (CSHs) provoked by cold exposure that may be age-dependent. We sought to characterize serum FGF21 and GDF-15 levels in pediatric cardiac arrest (CA) patients and their association with use of therapeutic hypothermia (TH).
Secondary analysis of serum samples from clinical trials. We measured FGF21 and GDF-15 levels in pediatric patients post-CA and compared levels to both pediatric intensive care (PICU) and healthy controls. Post-CA, we compared normothermia (NT) vs TH (33 °C for 72 h) treated cohorts at < 24 h, 24 h, 48 h, 72 h, and examined the change in CSHs over 72 h. We also assessed association between hospital mortality and initial levels.
We assessed 144 samples from 68 patients (27 CA [14 TH, 13 NT], 9 PICU and 32 healthy controls). Median initial FGF21 levels were higher post-CA vs. healthy controls (392 vs. 40 pg/mL, respectively, P < 0.001). Median GDF-15 levels were higher post-CA vs. healthy controls (7,089 vs. 396 pg/mL, respectively, P < 0.001). In the CA group, the median change in FGF21 from PICU day 1-3 (after 72 h of temperature control), was higher in TH vs. NT (231 vs. -20 pg/mL, respectively, P < 0.05), with no difference in GDF-15 over time. Serum GDF-15 levels were higher in CA patients that died vs. survived (19,450 vs. 5,337 pg/mL, respectively, P < 0.05), whereas serum FGF21 levels were not associated with mortality.
Serum levels of FGF21 and GDF-15 increased after pediatric CA, and FGF21 appears to be augmented by TH.
成纤维细胞生长因子 21（FGF21）和生长分化因子 15（GDF-15）是推测的神经保护冷应激激素（CSHs），由冷暴露引发，可能具有年龄依赖性。我们试图描述儿科心搏骤停（CA）患者血清中 FGF21 和 GDF-15 的水平，并探讨其与低温治疗（TH）的关系。
对临床试验中的血清样本进行二次分析。我们测量了儿科 CA 患者发病后的 FGF21 和 GDF-15 水平，并将其与儿科重症监护病房（PICU）和健康对照组进行比较。发病后，我们比较了 24 小时内、24 小时、48 小时、72 小时内接受常规体温（NT）和 TH（33°C 持续 72 小时）治疗的两组患者的水平，并观察了 72 小时内 CSH 的变化。我们还评估了初始水平与住院死亡率之间的关系。
我们评估了 68 例患者的 144 个样本（27 例 CA[14 例 TH，13 例 NT]，9 例 PICU 和 32 例健康对照组）。与健康对照组相比，CA 患者的初始 FGF21 水平更高（分别为 392pg/ml 和 40pg/ml，P<0.001）。CA 患者的 GDF-15 水平高于健康对照组（分别为 7089pg/ml 和 396pg/ml，P<0.001）。在 CA 组中，TH 组与 NT 组相比，从 PICU 第 1 天到第 3 天（体温控制 72 小时后）FGF21 的中位数变化更大（分别为 231pg/ml 和-20pg/ml，P<0.05），而 GDF-15 在整个时间内无差异。与存活患者相比，死亡患者的血清 GDF-15 水平更高（分别为 19450pg/ml 和 5337pg/ml，P<0.05），而血清 FGF21 水平与死亡率无关。
儿科 CA 后血清 FGF21 和 GDF-15 水平升高，FGF21 似乎由 TH 增强。
