Serial soluble neurofilament heavy chain in plasma as a marker of brain injury after cardiac arrest 英文参考文献.docVIP

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Serial soluble neurofilament heavy chain in plasma as a marker of brain injury after cardiac arrest 英文参考文献.doc

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Serial soluble neurofilament heavy chain in plasma as a marker of brain injury after cardiac arrest 英文参考文献

Rundgrenetal.CriticalCare2012,16:R45 /content/16/2/R45 RESEARCH OpenAccess Serialsolubleneurofilamentheavychainin plasmaasamarkerofbraininjuryafter cardiacarrest MalinRundgren1*,HansFriberg1,TobiasCronberg2,BertilRomner3andAxelPetzold4,5 Abstract Introduction:Inducedhypothermiahasbeenshowntoimproveoutcomeaftercardiacarrest,butearly prognosticationishamperedbytheneedforsedation.Herewetestedwhetherabiomarkerfor neurodegeneration,theneurofilamentheavychain(NfH),mayimprovediagnosticaccuracyinthefirstdaysafter cardiacarrest. Methods:Thisprospectivestudyincluded90consecutivepatientstreatedwithhypothermiaaftercardiacarrest. PlasmalevelsofphosphorylatedNfH(SMI35)werequantifiedusingstandardELISAoveraperiodof72hafter cardiacarrest.TheprimaryoutcomewasthedichotomizedCerebralPerformanceCategoriesscale(CPC).Abest CPC1-2during6monthsfollow-upwasconsideredagoodoutcome,abestCPCof3-4apooroutcome.Receiver operatorcharacteristicsandareaunderthecurvewerecalculated. Results:Themedianageofthepatientswas65years,and63(70%)weremale.Acardiacaetiologywasidentified in62cases(69%).77patients(86%)hadout-of-hospitalcardiacarrest.Theoutcomewasgoodin48andpoorin 42patients.PlasmaNfHlevelsweresignificantlyhigher2and36hoursaftercardiacarrestinpatientswithpoor outcome(median0.28ng/mLand0.5ng/mL,respectively)comparedtothosewithgoodoutcome(0ng/mL,p= 0.016,p0.005,respectively).TherespectiveAUCwere0.72and0.71. Conclusions:PlasmaNfHlevelscorrelatetoneurologicalprognosisfollowingcardiacarrest.Inthisstudy,15 patientshadneurologicalco-morbiditiesandtherewasaconsiderableoverlapofdata.Assuch,neurofilament shouldnotbeusedforroutineneuroprognosticationuntilmoredataareavailable. Introduction delaysthemetabolismofdrugs[7]andmakesaclinical Post cardiac arrest intensive care is complex and the neurological examination less reliable [8,9]. Therefore, dynamic multi-organ failure isoften referred toasthe weneedtoreassessandimproveourprognosticinstru- post-resuscitation syndrome [1]. The major cause of mentsandexplor