糖萼脱落成分升高作为心脏骤停患者不良预后的早期预测指标：一项单中心观察性研究。

Elevated glycocalyx shedding components as the early predictors of unfavorable outcomes in patients after cardiac arrest: A single-center observational study.

作者信息

He Dan, Hu Shuqun, Zhao Ningjun, Yan Xianliang, Su Chenglei

机构信息

Department of Emergency Medicine Center, the Shapingba Hospital Affilated to Chongqing University, Chongqing, 404100, China; Department of Emergency Medicine Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China.

Department of Emergency Medicine Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China.

出版信息

J Crit Care. 2025 Jun;87:155026. doi: 10.1016/j.jcrc.2025.155026. Epub 2025 Jan 24.

DOI:10.1016/j.jcrc.2025.155026

PMID:39862619

Abstract

OBJECTIVE

To assess the association of serum glycocalyx shedding components (Heparan sulfate, HS; Hyaluronic acid, HA; Syndecan-1, Sdc-1) with outcomes after CA.

METHODS

Patients who were comatose for >24 h after CA in the intensive care unit (ICU) of the Affiliated Hospital of Xuzhou Medical University from 9/2021 to 04/2023 were enrolled. Serum samples were collected 24 h after CA to measure the concentrations of glycocalyx shedding components. The outcomes were the 30-day Cerebral Performance Categories (CPC) scale and 30-day mortality. The association of glycocalyx shedding with outcomes was examined by regression analysis. The area under the curve was used to evaluate the value of glycocalyx shedding for predicting outcomes. Sensitivity analysis and subgroup analysis were conducted.

RESULTS

111 patients were enrolled. The unfavorable group (CPC 3-5, n = 69) had significantly higher serum concentrations of HA and Sdc-1 than the favorable group (CPC 1-2, n = 42) (HA:149.7 ng/ml vs. 824.8 ng/ml, P < 0.001; Sdc-1: 303.8 ng/L vs. 447.0 ng/L, P = 0.026)but not HS. Elevated serum HA concentrations was an independent risk factor for unfavorable 30-day neurological function (OR = 2.485, 95 % CI = 1.656-3.729). For the 30-day mortality, the nonsurvivor group (n = 53) had significantly higher serum concentrations of HA, HS and Sdc-1 (HA: 177.3 ng/ml vs. 1106.7 ng/ml, P < 0.001; HS: 2403.7 ng/ml vs. 3383.3 ng/ml P = 0.030; Sdc-1: 352.1 ng/L vs. 487.8 ng/L, P = 0.005) than the survivor group (n = 58). However, only elevated serum HA and Sdc-1 concentrations are independent risk factors for 30-day mortality (HA: HR = 2.321, 95 % CI = 1.776-3.035; Sdc-1: HR = 1.702, 95 % CI = 1.038-2.792).

CONCLUSIONS

Elevated serum HA at 24 h after CA is an independent risk factor for 30-day unfavorable neurological function or mortality and elevated serum Sdc-1 concentrations is an independent risk factor for 30-day mortality. Our results suggested the potential value of serum glycocalyx shedding components as predictors for the outcomes in post-CA patients.

摘要

目的

评估血清糖萼脱落成分（硫酸乙酰肝素、HS；透明质酸、HA；多配体蛋白聚糖-1、Sdc-1）与心脏骤停（CA）后预后的相关性。

方法

纳入2021年9月至2023年4月在徐州医科大学附属医院重症监护病房（ICU）CA后昏迷超过24小时的患者。CA后24小时采集血清样本，测定糖萼脱落成分的浓度。观察指标为30天脑功能分类（CPC）量表和30天死亡率。通过回归分析检验糖萼脱落与预后的相关性。采用曲线下面积评估糖萼脱落对预后的预测价值。进行敏感性分析和亚组分析。

结果

共纳入111例患者。不良组（CPC 3-5，n = 69）血清HA和Sdc-1浓度显著高于良好组（CPC 1-2，n = 42）（HA：149.7 ng/ml对824.8 ng/ml，P < 0.001；Sdc-1：303.8 ng/L对447.0 ng/L，P = 0.026），但HS无差异。血清HA浓度升高是30天神经功能不良的独立危险因素（OR = 2.485，95%CI = 1.656-3.729）。对于30天死亡率，非存活组（n = 53）血清HA、HS和Sdc-1浓度显著高于存活组（n = 58）（HA：177.3 ng/ml对1106.7 ng/ml，P < 0.001；HS：2403.7 ng/ml对3383.3 ng/ml，P = 0.030；Sdc-1：352.1 ng/L对487.8 ng/L，P = 0.005）。然而，只有血清HA和Sdc-1浓度升高是30天死亡率的独立危险因素（HA：HR = 2.321，95%CI = 1.776-3.035；Sdc-1：HR = 1.702，95%CI = 1.038-2.792）。