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Abstract：
BACKGROUND: We aimed to observe the dynamic changes in glucose metabolic reprogramming-related parameters and their ability to predict neurological prognosis and all-cause mortality in cardiac arrest patients after the restoration of spontaneous circulation (ROSC).
METHODS: Adult cardiac arrest patients after ROSC who were admitted to the emergency or cardiac intensive care unit of the First Affiliated Hospital of Dalian Medical University from August 1, 2017, to May 30, 2021, were enrolled. According to 28-day survival, the patients were divided into a non-survival group (n=82) and a survival group (n=38). Healthy adult volunteers (n=40) of similar ages and sexes were selected as controls. The serum levels of glucose metabolic reprogramming-related parameters (lactate dehydrogenase [LDH], lactate and pyruvate), neuron-specific enolase (NSE) and interleukin 6 (IL-6) were measured on days 1, 3, and 7 after ROSC. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Sequential Organ Failure Assessment (SOFA) score were calculated. The Cerebral Performance Category (CPC) score was recorded on day 28 after ROSC.
RESULTS: Following ROSC, the serum LDH (607.0 U/L vs. 286.5 U/L), lactate (5.0 mmol/L vs. 2.0 mmol/L), pyruvate (178.0 μmol/L vs. 70.9 μmol/L), and lactate/pyruvate ratio (34.1 vs. 22.1) significantly increased and were higher in the non-survivors than in the survivors on admission (all P<0.05). Moreover, the serum LDH, pyruvate, IL-6, APACHE II score, and SOFA score on days 1, 3 and 7 after ROSC were significantly associated with 28-day poor neurological prognosis and 28-day all-cause mortality (all P<0.05). The serum LDH concentration on day 1 after ROSC had an area under the receiver operating characteristic curve (AUC) of 0.904 [95% confidence interval [95% CI]: 0.851-0.957]) with 96.8% specificity for predicting 28-day neurological prognosis and an AUC of 0.950 (95% CI: 0.911-0.989) with 94.7% specificity for predicting 28-day all-cause mortality, which was the highest among the glucose metabolic reprogramming-related parameters tested.
CONCLUSIONS: Serum parameters related to glucose metabolic reprogramming were significantly increased after ROSC. Increased serum LDH and pyruvate levels, and lactate/pyruvate ratio may be associated with 28-day poor neurological prognosis and all-cause mortality after ROSC, and the predictive efficacy of LDH during the first week was superior to others.
METHODS: Adult cardiac arrest patients after ROSC who were admitted to the emergency or cardiac intensive care unit of the First Affiliated Hospital of Dalian Medical University from August 1, 2017, to May 30, 2021, were enrolled. According to 28-day survival, the patients were divided into a non-survival group (n=82) and a survival group (n=38). Healthy adult volunteers (n=40) of similar ages and sexes were selected as controls. The serum levels of glucose metabolic reprogramming-related parameters (lactate dehydrogenase [LDH], lactate and pyruvate), neuron-specific enolase (NSE) and interleukin 6 (IL-6) were measured on days 1, 3, and 7 after ROSC. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Sequential Organ Failure Assessment (SOFA) score were calculated. The Cerebral Performance Category (CPC) score was recorded on day 28 after ROSC.
RESULTS: Following ROSC, the serum LDH (607.0 U/L vs. 286.5 U/L), lactate (5.0 mmol/L vs. 2.0 mmol/L), pyruvate (178.0 μmol/L vs. 70.9 μmol/L), and lactate/pyruvate ratio (34.1 vs. 22.1) significantly increased and were higher in the non-survivors than in the survivors on admission (all P<0.05). Moreover, the serum LDH, pyruvate, IL-6, APACHE II score, and SOFA score on days 1, 3 and 7 after ROSC were significantly associated with 28-day poor neurological prognosis and 28-day all-cause mortality (all P<0.05). The serum LDH concentration on day 1 after ROSC had an area under the receiver operating characteristic curve (AUC) of 0.904 [95% confidence interval [95% CI]: 0.851-0.957]) with 96.8% specificity for predicting 28-day neurological prognosis and an AUC of 0.950 (95% CI: 0.911-0.989) with 94.7% specificity for predicting 28-day all-cause mortality, which was the highest among the glucose metabolic reprogramming-related parameters tested.
CONCLUSIONS: Serum parameters related to glucose metabolic reprogramming were significantly increased after ROSC. Increased serum LDH and pyruvate levels, and lactate/pyruvate ratio may be associated with 28-day poor neurological prognosis and all-cause mortality after ROSC, and the predictive efficacy of LDH during the first week was superior to others.
摘要：
背景：我们旨在观察自主循环（ROSC）恢复后心脏骤停患者葡萄糖代谢重编程相关参数的动态变化及其预测神经系统预后和全因死亡率的能力。
方法：选择2017年8月1日至2021年5月30日于大连医科大学附属第一医院急诊或心脏重症监护病房收治的ROSC术后心脏骤停成人患者。根据28天生存率,将患者分为非生存组(n=82)和生存组(n=38).选择年龄和性别相似的健康成年志愿者（n=40）作为对照。血清葡萄糖代谢重编程相关参数（乳酸脱氢酶[LDH]，乳酸和丙酮酸)，在ROSC后第1,3和7天检测神经元特异性烯醇化酶(NSE)和白细胞介素6(IL-6).计算急性生理学和慢性健康评估II（APACHEII）评分和序贯器官衰竭评估（SOFA）评分。在ROSC后第28天记录脑性能分类(CPC)评分。
结果：在ROSC之后，血清LDH(607.0U/Lvs.286.5U/L)，乳酸（5.0mmol/Lvs.2.0mmol/L)，丙酮酸盐(178.0μmol/Lvs.70.9μmol/L)，和乳酸/丙酮酸比率（34.1vs.22.1）显着增加，非幸存者比入院时幸存者高（均P<0.05）。此外，血清LDH，丙酮酸,IL-6,APACHEII评分,ROSC术后第1、3和7天的SOFA评分与28天神经功能不良预后和28天全因死亡率显著相关(均P<0.05)。ROSC后第1天的血清LDH浓度的受试者工作特征曲线下面积（AUC）为0.904[95％置信区间[95％CI]：0.851-0.957]），预测28天神经系统预后的特异性为96.8％，AUC为0.950（95％CI：0.911-0.989），预测28天全因死亡率的特异性为94.7％，在测试的葡萄糖代谢重编程相关参数中，这是最高的。
结论：ROSC后与葡萄糖代谢重编程相关的血清参数显著升高。血清LDH和丙酮酸水平升高，乳酸/丙酮酸比值可能与ROSC后28天神经系统预后不良和全因死亡率相关，并且在第一周LDH的预测功效优于其他。
方法：选择2017年8月1日至2021年5月30日于大连医科大学附属第一医院急诊或心脏重症监护病房收治的ROSC术后心脏骤停成人患者。根据28天生存率,将患者分为非生存组(n=82)和生存组(n=38).选择年龄和性别相似的健康成年志愿者（n=40）作为对照。血清葡萄糖代谢重编程相关参数（乳酸脱氢酶[LDH]，乳酸和丙酮酸)，在ROSC后第1,3和7天检测神经元特异性烯醇化酶(NSE)和白细胞介素6(IL-6).计算急性生理学和慢性健康评估II（APACHEII）评分和序贯器官衰竭评估（SOFA）评分。在ROSC后第28天记录脑性能分类(CPC)评分。
结果：在ROSC之后，血清LDH(607.0U/Lvs.286.5U/L)，乳酸（5.0mmol/Lvs.2.0mmol/L)，丙酮酸盐(178.0μmol/Lvs.70.9μmol/L)，和乳酸/丙酮酸比率（34.1vs.22.1）显着增加，非幸存者比入院时幸存者高（均P<0.05）。此外，血清LDH，丙酮酸,IL-6,APACHEII评分,ROSC术后第1、3和7天的SOFA评分与28天神经功能不良预后和28天全因死亡率显著相关(均P<0.05)。ROSC后第1天的血清LDH浓度的受试者工作特征曲线下面积（AUC）为0.904[95％置信区间[95％CI]：0.851-0.957]），预测28天神经系统预后的特异性为96.8％，AUC为0.950（95％CI：0.911-0.989），预测28天全因死亡率的特异性为94.7％，在测试的葡萄糖代谢重编程相关参数中，这是最高的。
结论：ROSC后与葡萄糖代谢重编程相关的血清参数显著升高。血清LDH和丙酮酸水平升高，乳酸/丙酮酸比值可能与ROSC后28天神经系统预后不良和全因死亡率相关，并且在第一周LDH的预测功效优于其他。
