Walther Janine, Schmandt Mathias, Muenster Stefan, Kreyer Stefan Franz X, Thudium Marcus, Lehmann Felix, Zimmermann Julian, Putensen Christian, Schewe Jens-Christian, Weller Johannes, Ehrentraut Stefan Felix
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Department of Neurology, University Hospital Bonn, Bonn, Germany.
Sci Rep. 2024 Dec 18;14(1):30545. doi: 10.1038/s41598-024-82898-3.
Neurological complications in patients undergoing veno-venous extracorporeal membrane oxygenation (V-V ECMO) are challenging, with new intracranial pathologies posing a grave risk. We aimed to evaluate the utility of neuron-specific enolase (NSE) and S100B biomarkers for predicting outcomes in new-onset intracranial pathology during V-V ECMO. A retrospective analysis spanning 2013-2021 at a German university hospital was conducted. Cases with electronically available data on NSE and S100B serum levels, new intracranial pathologies (intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], cerebral ischemia, hypoxic-ischemic encephalopathy [HIE]), and survival during or after V-V ECMO were screened. The primary objective was to assess the prognostic value of NSE and S100B for in-hospital survival during V-V ECMO. Secondary objectives included analyzing clinical characteristics, outcome parameters, and biomarker distribution in V-V ECMO patients. Additionally, the prognostic value of NSE and S100B for in-hospital death and occurrence of intracranial pathology was calculated. Among 744 ECMO recipients, 426 underwent V-V ECMO. No significant differences in disease severity or organ failure scores were observed between groups, except for SAPS at discharge, which was higher in patients with new intracranial pathologies. Patients with new intracranial pathologies had lower median survival and higher in-hospital mortality. Weaning success from ECMO was also significantly reduced in these patients. Cut-off values of 58.4 µg/lfor NSE and 1.52 µg/l for S100B were associated with detrimental outcomes, characterized by significantly reduced median survival. A significant difference in maximum serum NSE concentration was found between patients with and without new intracranial pathology. All screened cases with new intracranial pathology had an unfavorable neurological outcome (modified Rankin Score [mRS] > 3) at discharge, with a higher proportion having an mRS of 6 in the high NSE group. The emergence of intracranial pathology during V-V ECMO significantly increases the risk of death. Changes in NSE and S100B levels serve as valuable follow-up parameters for predicting new intracranial pathology and survival during V-V ECMO therapy.
接受静脉-静脉体外膜肺氧合（V-V ECMO）治疗的患者出现神经并发症具有挑战性，新的颅内病变带来严重风险。我们旨在评估神经元特异性烯醇化酶（NSE）和S100B生物标志物在预测V-V ECMO期间新发颅内病变预后方面的效用。对德国一家大学医院2013年至2021年的数据进行了回顾性分析。筛选出电子记录中有NSE和S100B血清水平、新发颅内病变（脑出血[ICH]、蛛网膜下腔出血[SAH]、脑缺血、缺氧缺血性脑病[HIE]）以及V-V ECMO期间或之后生存情况的数据的病例。主要目的是评估NSE和S100B对V-V ECMO期间院内生存的预后价值。次要目的包括分析V-V ECMO患者的临床特征、结局参数和生物标志物分布。此外，还计算了NSE和S100B对院内死亡和颅内病变发生的预后价值。在744名接受ECMO治疗的患者中，426名接受了V-V ECMO治疗。除出院时的简化急性生理学评分（SAPS）外，各组之间在疾病严重程度或器官衰竭评分方面未观察到显著差异，新发颅内病变患者的SAPS更高。新发颅内病变患者的中位生存期较短，院内死亡率较高。这些患者从ECMO撤机的成功率也显著降低。NSE的临界值为58.4 μg/l，S100B的临界值为1.52 μg/l与不良结局相关，其特征是中位生存期显著缩短。有新发颅内病变和无新发颅内病变的患者之间，血清NSE最高浓度存在显著差异。所有筛查出的新发颅内病变病例出院时神经功能结局均不佳（改良Rankin量表[mRS]＞3），高NSE组中mRS为6的比例更高。V-V ECMO期间颅内病变的出现显著增加了死亡风险。NSE和S100B水平的变化是预测V-V ECMO治疗期间新发颅内病变和生存情况的有价值的随访参数。
