Department of Intensive Internal Medicine, University Medical Centre Ljubljana, Zaloska cesta 7, 1000 Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia.
Medicina (Kaunas). 2024 Aug 9;60(8):1286. doi: 10.3390/medicina60081286.
: Most patients who are successfully resuscitated from cardiac arrest remain comatose, and only half regain consciousness 72 h after the arrest. Neuroprognostication methods can be complex and even inconclusive. As mitochondrial components have been identified as markers of post-cardiac-arrest injury and associated with survival, we aimed to investigate cytochrome c and mtDNA in comatose patients after cardiac arrest to compare neurological outcomes and to evaluate the markers' neuroprognostic value. : This prospective observational study included 86 comatose post-cardiac-arrest patients and 10 healthy controls. Cytochrome c and mtDNA were determined at admission. Neuron-specific enolase (NSE) was measured after 72 h. Additional neuroprognostication methods were performed when patients remained unconscious. Cerebral performance category (CPC) was determined. : Cytochrome c was elevated in patients compared to healthy controls (2.029 [0.85-4.97] ng/mL vs. 0 [0.0-0.16], < 0.001) but not mtDNA (95,228 [52,566-194,060] vs. 41,466 [28,199-104,708] copies/μL, = 0.074). Compared to patients with CPC 1-2, patients with CPC 3-5 had higher cytochrome c (1.735 [0.717-3.40] vs. 4.109 [1.149-8.457] ng/mL, = 0.011), with no differences in mtDNA (87,855 [47,598-172,464] vs. 126,452 [69,447-260,334] copies/μL, = 0.208). Patients with CPC 1-2 and CPC 3-5 differed in all neuroprognostication methods. In patients with good vs. poor neurological outcome, ROC AUC was 0.664 ( = 0.011) for cytochrome c, 0.582 ( = 0.208) for mtDNA, and 0.860 ( < 0.001) for NSE. The correlation between NSE and cytochrome c was moderate, with a coefficient of 0.576 ( < 0.001). : Cytochrome c was higher in comatose patients after cardiac arrest compared to healthy controls and higher in post-cardiac-arrest patients with poor neurological outcomes. Although cytochrome c correlated with NSE, its neuroprognostic value was poor. We found no differences in mtDNA.
: 大多数从心脏骤停中成功复苏的患者仍处于昏迷状态，只有一半在心脏骤停后 72 小时恢复意识。神经预后评估方法可能很复杂，甚至无法得出结论。由于线粒体成分已被确定为心脏骤停后损伤的标志物，并与存活率相关，我们旨在研究心脏骤停后昏迷患者的细胞色素 c 和 mtDNA，以比较神经结局，并评估标志物的神经预后价值。 : 这项前瞻性观察研究纳入了 86 例心脏骤停后昏迷的患者和 10 例健康对照者。入院时测定细胞色素 c 和 mtDNA。72 小时后测定神经元特异性烯醇化酶（NSE）。当患者仍无意识时，进行额外的神经预后评估方法。采用脑功能预后评分（CPC）进行评估。 : 与健康对照组相比，患者的细胞色素 c 升高（2.029 [0.85-4.97]ng/ml 比 0 [0.0-0.16]， < 0.001），但 mtDNA 没有升高（95,228 [52,566-194,060]copies/μL 比 41,466 [28,199-104,708]copies/μL， = 0.074）。与 CPC 1-2 患者相比，CPC 3-5 患者的细胞色素 c 更高（1.735 [0.717-3.40]ng/ml 比 4.109 [1.149-8.457]ng/ml， = 0.011），而 mtDNA 无差异（87,855 [47,598-172,464]copies/μL 比 126,452 [69,447-260,334]copies/μL， = 0.208）。CPC 1-2 和 CPC 3-5 的患者在所有神经预后评估方法上均存在差异。在神经功能良好与不良的患者中，细胞色素 c 的 ROC AUC 为 0.664（ = 0.011），mtDNA 为 0.582（ = 0.208），NSE 为 0.860（ < 0.001）。NSE 与细胞色素 c 之间的相关性为中度，相关系数为 0.576（ < 0.001）。 : 与健康对照组相比，心脏骤停后昏迷的患者细胞色素 c 水平升高，且神经结局不良的心脏骤停后患者细胞色素 c 水平更高。虽然细胞色素 c 与 NSE 相关，但神经预后价值较差。我们没有发现 mtDNA 的差异。
