Neurology:心肺复苏后预测不良结局的NSE阈值

2022-02-11 杨中华 “ 脑血管病及重症文献导读”公众号

血清神经元特异性烯醇化酶(NSE)作为预测缺氧性脑损伤预后的生物标志物,在过去20年中一直是许多研究的主题。

血清神经元特异性烯醇化酶(NSE)作为预测缺氧性脑损伤预后的生物标志物,在过去20年中一直是许多研究的主题。在2006年美国神经病学学会(American Academy of Neurology)关于心脏骤停后预后的实践参数中,建议采用1-3天的血清NSE>33 ng/mL作为预测不良预后的阈值,假阳性率(FPR)<3%(译者注:2021 ERC/ESICM心肺复苏后的管理指南认为,在48h 和/或72h 时神经元特异性烯醇化酶(NSE)>60μg/L,提示预后不良)。然而,多项研究随后报告,这个阈值的FPR要高得多。

2022年1月来自美国的Kartavya Sharma等在Neurology上发表了他们的系统性综述和meta分析结果,他们采用一种独特的多阈值meta分析的方法,以>95%的特异性来确定预测心脏停搏后不良结局的NSE阈值

数据来自于11项研究(n=1,982)在0–24小时的数据,21项研究(n=2,815)在24–48小时的数据,以及13项研究(n=2,557)在48–72小时的数据。在24至48小时和48至72小时,用于预测不良结果的曲线下面积显着大于0至24小时(0.82和0.83 vs 0.64)。因为掺合偏倚的风险(NSE水平可能影响了撤离生命支持的决策),大多数研究的证据质量很低。为了尽量减少错误的悲观预测(pessimistic predictions),以95%上限的NSE阈值作为预测区间(prediction intervals)。对于特异性大于95%的不良结局预测,在24-48h时NSE的预测区间上限为70.4 ng/mL,48–72h时为58.6 ng/mL。敏感性分析(排除了使用不一致的目标体温管理或不同的结局标准的研究)并没有显着改变这个结果。

最终作者认为,预测不良结局的高特异性NSE阈值远高于一般使用的标准。未来的研究必须尽量减少偏倚,方法是不把预测结果告诉治疗团队,并预先设定撤离生命支持的标准

原始出处:

Kartavya Sharma, Merin John, Song Zhang, et al. Serum Neuron-Specific Enolase Thresholds for Predicting Postcardiac Arrest Outcome: A Systematic Review and Meta-analysis. Neurology. 2022 Jan 4;98(1):e62-e72.

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    2022-08-06 yinhl1978
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    2022-09-02 aids222
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    2022-02-13 lizhou0204
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    2022-02-13 qjddjq

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