Department of Emergency Medicine, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China.
Department of Emergency Medicine, Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China.
Shock. 2024 Sep 1;62(3):310-318. doi: 10.1097/SHK.0000000000002378. Epub 2024 May 23.
Objective : To explore the association of serum transactive response DNA binding protein 43 (TDP-43) with 28-day poor neurologic outcome in patients with return of spontaneous circulation (ROSC) after cardiac arrest. Methods : We performed a study between January and December 2023. Eligible patients with ROSC following cardiac arrest were enrolled. Their baseline characteristics were collected, and serum levels of TDP-43, tumor necrosis factor-α, interleukin-6 and 10, C-reactive protein, and neuron-specific enolase (NSE) at 24 h after ROSC were measured. The neurologic function was assessed by the cerebral performance category scores on day 28 after ROSC. Results : A total of 92 patients were included, with 51 and 41 patients in the good and poor neurologic outcome groups, respectively. Serum TDP-43 was significantly higher in the poor than the good neurologic outcome group ( P < 0.05). Univariate and multivariate logistic regression analyses showed that TDP-43, Witnessed CA, IL-6, and NSE were associated with poor 28-day neurologic outcome (all P < 0.05). Restricted cubic spline analysis revealed that TDP-43 at the serum level of 11.64 pg/mL might be an ideal cutoff value for distinguishing between good and poor neurologic outcomes. Area under curve of serum TDP-43 (AUC = 0.78) was close to that of serum NSE (AUC = 0.82). A dynamic nomogram prediction model that combined TDP-43, Witnessed CA, IL-6, and NSE was constructed and validated. Conclusion : Elevated serum TDP-43 level was associated with and could be used together with Witnessed CA, IL-6, and NSE to predict poor 28-day neurologic outcome in patients after ROSC following cardiac arrest.
探讨血清转导反应 DNA 结合蛋白 43（TDP-43）与心脏骤停后自主循环恢复（ROSC）患者 28 天不良神经结局的关系。方法：我们于 2023 年 1 月至 12 月进行了一项研究。纳入符合条件的 ROSC 后心脏骤停患者。收集其基线特征，并在 ROSC 后 24 小时测量血清 TDP-43、肿瘤坏死因子-α、白细胞介素-6 和 10、C-反应蛋白和神经元特异性烯醇化酶（NSE）水平。通过 ROSC 后第 28 天的脑功能分类评分评估神经功能。结果：共纳入 92 例患者，其中良好神经结局组和不良神经结局组分别为 51 例和 41 例。不良神经结局组的血清 TDP-43 明显高于良好神经结局组（P<0.05）。单因素和多因素逻辑回归分析显示，TDP-43、目击 CA、IL-6 和 NSE 与 28 天不良神经结局相关（均 P<0.05）。限制性立方样条分析显示，血清 TDP-43 水平为 11.64pg/mL 可能是区分良好和不良神经结局的理想截断值。血清 TDP-43 的曲线下面积（AUC=0.78）接近血清 NSE 的 AUC（AUC=0.82）。构建并验证了一个包含 TDP-43、目击 CA、IL-6 和 NSE 的动态列线图预测模型。结论：血清 TDP-43 水平升高与心脏骤停后 ROSC 患者 28 天不良神经结局相关，可与目击 CA、IL-6 和 NSE 联合用于预测不良神经结局。
