目的:心脏骤停(CA)后患者的良好结局通常定义为脑功能类别(CPC)1-2,而CPC3则存在争议,和CPC4-5代表较差的结果。我们旨在评估修改后的Rankin量表(mRS)何时可以改善CPC结果描述,特别是在CPC3中。我们进一步旨在将神经元特异性烯醇化酶(NSE)与两种功能措施相关联,以探索它们与神经元损伤的关系。
方法:前48小时内达到NSE峰值,在2016年4月至2023年4月期间,前瞻性收集了665名连续昏迷的成年人在3个月时的CPC和3个月时的mRS。对于每个CPC类别,mRS被描述。我们认为良好的结果是mRS1-3,符合现有的建议。使用非参数评估将CPC和mRS与峰值血清NSE相关联。
结果:CPC1、2、4和5在良好和不良结果方面与mRS几乎完全相关。然而,CPC3与二分mRS异质相关(53.1%的患者预后良好(mRS0-3),46.9%的不良结果(mRS4-6))。NSE与CPC(Spearman的rho0.616P<0.001)和mRS(Spearman的rho0.613P<0.001)密切相关。
结论:CPC和mRS与神经元损伤相似。虽然CPC1-2和CPC4-5与mRS0-3和,分别,使用mRS5-6,CPC3是异质的:在此类别中可以找到好的和差的mRS分数。因此,我们建议应在CPC3患者中常规评估mRS,以完善结局描述.
Good outcome in patients following cardiac arrest (CA) is usually defined as Cerebral Performance Category (CPC) 1-2, while
CPC 3 is debated, and
CPC 4-5 represent poor outcome. We aimed to assess when the modified Rankin Scale (mRS) can improve CPC outcome description, especially in
CPC 3. We further aimed to correlate neuron specific enolase (NSE) with both functional measures to explore their relationship with neuronal damage.
Peak NSE within the first 48 hours, and CPC and mRS at 3 months were prospectively collected for 665 consecutive comatose adults following CA treated between April 2016 and April 2023. For each
CPC category, mRS was described. We considered good outcome as mRS 1-3, in line with existing recommendations. CPC and mRS were correlated to peak serum NSE using non-parametric assessments.
CPC 1, 2, 4 and 5 correlated almost perfectly with mRS in terms of good and poor outcomes. However, CPC 3 was heterogeneously associated to the dichotomized mRS (53.1% had good outcome (mRS 0-3), 46.9% poor outcome (mRS 4-6)). NSE was strongly correlated with CPC (Spearman\'s rho 0.616, P < 0.001) and mRS (Spearman\'s rho 0.613, P < 0.001).
CPC and mRS correlate similarly with neuronal damage. Whilst
CPC 1-2 and
CPC 4-5 are strongly associated with mRS 0-3 and, respectively, with mRS 5-6,
CPC 3 is heterogenous: both good and poor mRS scores are found within this category. Therefore, we suggest that the mRS should be routinely assessed in patients with CPC 3 to refine outcome description.