心脏骤停时的肠道损伤与多器官功能障碍相关：一项前瞻性队列研究。
Intestinal injury in cardiac arrest is associated with multiple organ dysfunction: A prospective cohort study.
作者信息
Hoftun Farbu Bjørn, Langeland Halvor, Ueland Thor, Michelsen Annika E, Jørstad Krüger Andreas, Klepstad Pål, Nordseth Trond
机构信息
Department of Anaesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway; Institute of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Norwegian Air Ambulance Foundation, Department of Research and Development, Oslo, Norway.
Department of Anaesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway; Institute of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
出版信息
Resuscitation. 2023 Apr;185:109748. doi: 10.1016/j.resuscitation.2023.109748. Epub 2023 Feb 25.
BACKGROUND
The impact of intestinal injury in cardiac arrest is not established. The first aim of this study was to assess associations between clinical characteristics in out-of-hospital cardiac arrest (OHCA) and a biomarker for intestinal injury, Intestinal Fatty Acid Binding Protein (IFABP). The second aim was to assess associations between IFABP and multiple organ dysfunction and 30-day mortality.
METHODS
We measured plasma IFABP in 50 patients at admission to intensive care unit (ICU) after OHCA. Demographic and clinical variables were analysed by stratifying patients on median IFABP, and by linear regression. We compared Sequential Organ Failure Assessment (SOFA) score, haemodynamic variables, and clinical-chemistry tests at day two between the "high" and "low" IFABP groups. Logistic regression was applied to assess factors associated with 30-day mortality.
RESULTS
Several markers of whole body ischaemia correlated with intestinal injury. Duration of arrest and lactate serum concentrations contributed to elevated IFABP in a multivariable model (p < 0.01 and p = 0.04, respectively). At day two, all seven patients who had died were in the "high" IFABP group, and all six patients who had been transferred to ward were in the "low" group. Of patients still treated in the ICU, the "high" group had higher total, renal and respiratory SOFA score (p < 0.01) and included all patients receiving inotropic drugs. IFABP predicted mortality (OR 16.9 per standard deviation increase, p = 0.04).
CONCLUSION
Cardiac arrest duration and lactate serum concentrations were risk factors for intestinal injury. High levels of IFABP at admission were associated with multiple organ dysfunction and mortality.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT02648061.
背景
心脏骤停时肠道损伤的影响尚未明确。本研究的首要目的是评估院外心脏骤停（OHCA）患者的临床特征与肠道损伤生物标志物——肠脂肪酸结合蛋白（IFABP）之间的关联。第二个目的是评估IFABP与多器官功能障碍及30天死亡率之间的关联。
方法
我们对50例OHCA后入住重症监护病房（ICU）的患者入院时的血浆IFABP进行了检测。通过根据IFABP中位数对患者进行分层以及线性回归分析人口统计学和临床变量。我们比较了“高”IFABP组和“低”IFABP组在第二天的序贯器官衰竭评估（SOFA）评分、血流动力学变量和临床化学检测结果。应用逻辑回归分析评估与30天死亡率相关的因素。
结果
全身缺血的几个标志物与肠道损伤相关。在多变量模型中，骤停持续时间和血清乳酸浓度导致IFABP升高（分别为p < 0.01和p = 0.04）。在第二天，所有7例死亡患者均在“高”IFABP组，所有6例转至病房的患者均在“低”IFABP组。在仍在ICU接受治疗的患者中，“高”IFABP组的总、肾脏和呼吸SOFA评分更高（p < 0.01），且包括所有接受血管活性药物治疗的患者。IFABP可预测死亡率（每标准差增加的OR为16.9，p = 0.04）。
结论
心脏骤停持续时间和血清乳酸浓度是肠道损伤的危险因素。入院时IFABP水平升高与多器官功能障碍及死亡率相关。
试验注册
ClinicalTrials.gov：NCT02648061。
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