Neurological Critical Illness
The value of early multi-indicator monitoring to predict the neurological prognosis in patients with post-cardiac arrest brain injury
Xu Guowu, Wang Jinxiang, Jin Heng
Published 2023-12-10
Cite as Chin J Emerg Med, 2023, 32(12): 1674-1679. DOI: 10.3760/cma.j.issn.1671-0282.2023.12.017
Abstract
ObjectiveTo investigate the predictive value of neuron-specific enolase (NSE), serum 100 calcium-binding protein β (S100β), gray-white-matter-ratio on head CT (GWR) and the combination of the three on the prognosis of neurological function in patients with post-cardiac arrest brain injury (PCABI).
MethodsA total of 136 patients admitted to Tianjin Medical University General Hospital after resuscitation from cardiac arrest from September 2021 to May 2023 were selected and included in the good prognosis group (96 patients) and the poor prognosis group (40 patients) based on the Glasgow-Pittsburgh Cerebral Performance (CPC) classification at discharge, respectively, to compare the demographic data, resuscitation data and NSE, S100β and GWR levels within 24 h of admission between the 2 groups, and modified Poisson regression was applied to investigate the factors affecting the neuroprognosis of PCABI patients. The effectiveness of NSE, S100β, GWR and the combination of the three in predicting neurological prognosis was evaluated using receiver operating characteristic (ROC) curve and the area under the curve (AUC), and the statistical differences in AUC were compared by Delong's test.
ResultsNSE, S100β, GWR, history of coronary artery disease, APACHEⅡ score, time from CA to CPR, duration of resuscitation, and dose of epinephrine use were independent factors influencing the neurological prognosis of PCABI patients (P<0.05). Compared with the good prognosis group, NSE and S100β levels were significantly higher and GWR levels were significantly lower in the poor prognosis group, with statistically significant differences (P<0.01). The AUCs for NSE, S100β and GWR to predict poor neurological prognosis were 0.905(0.851, 0.959), 0.876 (0.797, 0.956), 0.842(0.754, 0.930), with cut-off values of 26.75 ng/mL, 1.35 ng/mL and 1.195, respectively, and an AUC of 0.982 (0.961, 1.000) for the combination of the three predicting poor neurological prognosis, significantly higher than any single indicator (P=0.001 4, 0.001 6, 0.002 8).
ConclusionsEarly monitoring of NSE, S100β and GWR is effective in predicting the neurological prognosis of PCABI patients at discharge, and the combination of all three significantly improves the predictive power.
Key words:
Post-cardiac arrest brain injury; Neuron-specific enolase; Serum 100 calcium-binding protein β; Gray-white-matter-ratio on head CT; Neurological prognosis
Contributor Information
Xu Guowu
Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
Wang Jinxiang
Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
Jin Heng
Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
