Wang Ling, Li Rui-Fang, Guan Xiao-Lan, Liang Shuang-Shuang, Gong Ping
Department of Neurology, The Affiliated Jinyang Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
J Intensive Care. 2023 Feb 2;11(1):3. doi: 10.1186/s40560-023-00653-8.
sCD59, as a soluble form of CD59, is observed in multiple types of body fluids and correlated with the cell damage after ischemia/reperfusion injury. This study aims to observe the dynamic changes of serum sCD59 in patients after restoration of spontaneous circulation (ROSC) and explore the association of serum sCD59 with neurological prognosis and all-cause mortality in patients after ROSC.
A total of 68 patients after ROSC were prospectively recruited and divided into survivors (n = 23) and non-survivors (n = 45) groups on the basis of 28-day survival. Twenty healthy volunteers were enrolled as controls. Serum sCD59 and other serum complement components, including sC5b-9, C5a, C3a, C3b, C1q, MBL, Bb, and pro-inflammatory mediators tumor necrosis factor (TNF)-α, interleukin-6 (IL-6), neurological damage biomarkers neuron-specific enolase (NSE) and soluble protein 100β (S100β) were measured by enzyme linked immunosorbent assay on day 1, 3, and 7 after ROSC. Neurologic outcome was assessed using cerebral performance category scores, with poor neurologic outcome defined as 3-5 points.
In the first week after ROSC, serum levels of sCD59, sC5b-9, C5a, C3a, C3b, C1q, MBL, Bb, TNF-α, IL-6, NSE and S100β were significantly elevated in patients after ROSC compared to healthy volunteers, with a significant elevation in the non-survivors compared to survivors except serum C1q and MBL. Serum sCD59 levels were positively correlated with serum sC5b-9, TNF-α, IL-6, NSE, S100β, SOFA score and APACHE II score. Moreover, serum sCD59 on day 1, 3, and 7 after ROSC could be used for predicting poor 28-day neurological prognosis and all-cause mortality. Serum sCD59 on day 3 had highest AUCs for predicting poor 28-day neurological prognosis [0.862 (95% CI 0.678-0.960)] and 28-day all-cause mortality [0.891 (95% CI 0.769-0.962)]. In multivariate logistic regression analysis, the serum level of sCD59 was independently associated with poor 28-day neurological prognosis and all-cause mortality.
The elevated serum level of sCD59 was positively correlated with disease severity after ROSC. Moreover, serum sCD59 could have good predictive values for the poor 28-day neurological prognosis and all-cause mortality in patients after ROSC.
可溶性CD59（sCD59）作为CD59的一种可溶性形式，在多种体液中均可检测到，且与缺血/再灌注损伤后的细胞损伤相关。本研究旨在观察自主循环恢复（ROSC）后患者血清sCD59的动态变化，并探讨血清sCD59与ROSC后患者神经功能预后及全因死亡率的关系。
前瞻性纳入68例ROSC后患者，并根据28天生存率分为存活组（n = 23）和非存活组（n = 45）。纳入20名健康志愿者作为对照组。在ROSC后第1天、第3天和第7天，采用酶联免疫吸附测定法检测血清sCD59及其他血清补体成分，包括sC5b-9、C5a、C3a、C3b、C1q、MBL、Bb，以及促炎介质肿瘤坏死因子（TNF）-α、白细胞介素-6（IL-6）、神经损伤生物标志物神经元特异性烯醇化酶（NSE）和可溶性蛋白100β（S100β）。采用脑功能分类评分评估神经功能结局，神经功能结局不良定义为3 - 5分。
ROSC后第一周，与健康志愿者相比，ROSC后患者血清sCD59、sC5b-9、C5a、C3a、C3b、C1q、MBL、Bb、TNF-α、IL-6、NSE和S100β水平显著升高，除血清C1q和MBL外，非存活组与存活组相比显著升高。血清sCD59水平与血清sC5b-9、TNF-α、IL-6、NSE、S100β、序贯器官衰竭评估（SOFA）评分和急性生理与慢性健康状况评分系统II（APACHE II）评分呈正相关。此外，ROSC后第1天、第3天和第7天的血清sCD59可用于预测28天神经功能预后不良和全因死亡率。ROSC后第3天的血清sCD59预测28天神经功能预后不良[0.862（95%可信区间0.678 - 0.960）]和28天全因死亡率[0.891（95%可信区间0.769 - 0.962）]的曲线下面积最高。在多因素logistic回归分析中，血清sCD59水平与28天神经功能预后不良和全因死亡率独立相关。
ROSC后血清sCD59水平升高与疾病严重程度呈正相关。此外，血清sCD59对ROSC后患者28天神经功能预后不良和全因死亡率具有良好的预测价值。
