Janas Anna M, Miller Kristen R, Ceschin Rafael, Mourani Peter M, Ruzas Christopher M, Bennett Tellen D, Fink Ericka L, Maddux Aline B
Department of Pediatrics, Section of Critical Care, University of Colorado School of Medicine and Children's Hospital of Colorado, Aurora, CO.
Department of Pediatric Radiology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA.
Pediatr Crit Care Med. 2025 Jul 1;26(7):e915-e923. doi: 10.1097/PCC.0000000000003756. Epub 2025 Apr 28.
Brain MRI is used to inform prognosis of pediatric cardiac arrest (CA). We analyzed the association between early levels of four brain injury biomarkers and pattern of brain injury on MRI.
DESIGN, SETTING, AND PATIENTS: This secondary analysis of a multicenter prospective cohort study in 14 U.S. hospitals (from May 16, 2017, to August 19, 2020) recruited children 48 hours to 17 years old who were resuscitated after CA and had a brain MRI within 14 days postarrest.
None.
Brain MRI injury score was calculated as a sum of T2- and diffusion-weighted imaging lesions. We used the Kruskal-Wallis test to compare maximum biomarker values on days 1-3 between three categories of MRI injury severity (i.e., no injury, mild-moderate injury, and severe injury). Maximum neurofilament light chain (NfL), tubulin-associated unit, glial fibrillary acidic protein, and ubiquitin C-terminal hydrolase L1 levels were associated with severity of total injury, gray matter injury, and white matter injury. Using logistic regression, individual biomarker levels were associated with presence of injury on MRI after adjusting for age, presence of congenital heart disease, and severity of illness using Pediatric Index of Mortality 3 score. Of 40 patients with injury on MRI and 1-year outcome data, median (interquartile range [IQR]) NfL levels were higher in the 15 patients who died compared with the 21 patients with favorable outcome (7.10 pg/mL [IQR, 5.94-7.51 pg/mL] vs. 5.10 pg/mL [IQR, 4.10-5.94 pg/mL]; log transformed; p < 0.001), but we failed to identify a difference in levels between those with unfavorable outcome (Vineland Adaptive Behavior Score < 70, n = 4) vs. favorable outcome.
Blood biomarkers measured early after injury are associated with MRI injury and may provide additional information for prognostication when incorporated in a multimodal evaluation.
脑部磁共振成像（MRI）用于评估小儿心脏骤停（CA）的预后。我们分析了四种脑损伤生物标志物的早期水平与MRI脑损伤模式之间的关联。
设计、地点和患者：这是一项对美国14家医院（2017年5月16日至2020年8月19日）进行的多中心前瞻性队列研究的二次分析，研究对象为48小时至17岁的儿童，这些儿童在心脏骤停后接受了复苏，并在心脏骤停后14天内进行了脑部MRI检查。
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脑MRI损伤评分通过T2加权成像和弥散加权成像病变的总和来计算。我们使用Kruskal-Wallis检验比较MRI损伤严重程度的三类（即无损伤、轻度至中度损伤和重度损伤）在第1至3天的生物标志物最大值。神经丝轻链（NfL）、微管相关单位、胶质纤维酸性蛋白和泛素C末端水解酶L1的最大值与总损伤、灰质损伤和白质损伤的严重程度相关。使用逻辑回归分析，在调整年龄、先天性心脏病的存在以及使用小儿死亡率指数3评分评估的疾病严重程度后，个体生物标志物水平与MRI上损伤的存在相关。在40例有MRI损伤和1年预后数据的患者中，15例死亡患者的NfL水平中位数（四分位间距[IQR]）高于21例预后良好的患者（7.10 pg/mL [IQR，5.94 - 7.51 pg/mL] 对比 5.10 pg/mL [IQR，4.10 - 5.94 pg/mL]；对数转换后；p < 0.001），但我们未能识别出预后不良者（Vineland适应性行为评分 < 70，n = 4）与预后良好者之间的水平差异。
损伤后早期测量的血液生物标志物与MRI损伤相关，并且在纳入多模式评估时可能为预后提供额外信息。
