An Le, Shao Rui, Hang Chenchen, Wang Xingsheng, Zhang Luying, Cui Hao, Yu Jingfei, Shan Zhenyu, Tang Ziren
Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing 100020, China.
Resusc Plus. 2024 Nov 7;20:100822. doi: 10.1016/j.resplu.2024.100822. eCollection 2024 Dec.
Out-of-hospital cardiac arrest (OHCA) is a major public health problem. Acute respiratory distress syndrome (ARDS) is a common condition in OHCA patients. We investigated the relationship between the expression of programmed death-1 (PD-1) related molecules and the development and prognosis of ARDS.
Between January 2021 and December 2023, post-resuscitated patients were screened for eligibility in the study. PD-1 related molecules expression was measured by flow cytometry at 48 h of admission in patients with OHCA. The prognostic variables were the development of ARDS during hospitalization and the 28-day patient mortality rate. We analyzed the relationship between the expression of PD-1-related molecules and the development of secondary ARDS in OHCA patients, and assessed the correlation of this expression with the prognosis of ARDS patients.
In total, 107 consecutive OHCA patients were enrolled in this study. The median age of the enrolled patients was 60 years, with an age range of 53 to 67 years, and 71 % were male. Among the cardiac arrest patients, 44.8 % had a cardiac etiology, 30.8 % were witnessed, 17.8 % received bystander CPR, and 66.4 % had an initial rhythm of asystole. Our results showed that only monocyte ligand programmed death ligand-1 (PD-L1) expression was significantly elevated in the ARDS group of OHCA patients (P < 0.001). Among patients with ARDS, the expression of PD-L1 on monocytes in non-survivors was significantly higher than in survivors (P < 0.05). The Receiver operating characteristic curves analysis demonstrates that monocyte PD-L1 expression has predictive potential for the development and prognosis of ARDS. Multivariate logistic regression analysis showed that monocyte PD-L1 expression was an independent predictor of mortality in OHCA patients with ARDS.
This study indicates that patients with increased PD-L1 on monocytes after OHCA may be more likely to develop ARDS. The expression of PD-L1 on monocytes was an independent predictive factor for the incidence of ARDS and mortality rate in OHCA patients.
院外心脏骤停（OHCA）是一个重大的公共卫生问题。急性呼吸窘迫综合征（ARDS）是OHCA患者的常见病症。我们研究了程序性死亡-1（PD-1）相关分子的表达与ARDS发生发展及预后之间的关系。
2021年1月至2023年12月期间，对复苏后的患者进行筛选以确定其是否符合研究条件。在OHCA患者入院48小时时，通过流式细胞术检测PD-1相关分子的表达。预后变量为住院期间ARDS的发生情况及患者28天死亡率。我们分析了OHCA患者中PD-1相关分子表达与继发性ARDS发生之间的关系，并评估了该表达与ARDS患者预后的相关性。
本研究共纳入107例连续的OHCA患者。纳入患者的中位年龄为60岁，年龄范围为53至67岁，71%为男性。在心脏骤停患者中，44.8%有心脏病因，30.8%为目击骤停，17.8%接受了旁观者心肺复苏，66.4%初始心律为心搏停止。我们的结果显示，仅OHCA患者的ARDS组中单核细胞配体程序性死亡配体-1（PD-L1）表达显著升高（P<0.001）。在ARDS患者中，非幸存者单核细胞上PD-L1的表达显著高于幸存者（P<0.05）。受试者工作特征曲线分析表明，单核细胞PD-Ll表达对ARDS的发生发展及预后具有预测潜力。多因素逻辑回归分析显示，单核细胞PD-L1表达是OHCA合并ARDS患者死亡的独立预测因素。
本研究表明，OHCA后单核细胞上PD-L1增加的患者可能更易发生ARDS。单核细胞上PD-L1的表达是OHCA患者ARDS发生率及死亡率的独立预测因素。
