Brain biomarkers and management of uncertainty in predicting outcome of cardiopulmonary resuscitation: A nomogram paints a thousand words

被引:14
作者
Einav, Sharon [1 ,2 ]
Kaufman, Nechama [3 ]
Algur, Nurit [4 ]
Strauss-Liviatan, Nurith
Kark, Jeremy D. [5 ]
机构
[1] Hebrew Univ Jerusalem, Shaare Zedek Med Ctr, IL-91031 Jerusalem, Israel
[2] Hebrew Univ Jerusalem, Hadassah Fac Med, IL-91031 Jerusalem, Israel
[3] Shaare Zedek Med Ctr, Dept Emergency Med, Jerusalem, Israel
[4] Shaare Zedek Med Ctr, Gen Lab Facil, Jerusalem, Israel
[5] Hebrew Univ Jerusalem, Hadassah Braun Sch Publ Hlth & Community Med, Epidemiol Unit, IL-91031 Jerusalem, Israel
关键词
S-100 calcium-binding protein beta subunit; Neuron-specific enolase; Heart arrest; Cardiopulmonary resuscitation; Epidemiology; Evidence-based medicine; Decision support techniques; Prognosis; Biological markers; NEURON-SPECIFIC ENOLASE; HOSPITAL CARDIAC-ARREST; MYOCARDIAL-INFARCTION; UNIVERSAL DEFINITION; BIOCHEMICAL MARKERS; COMATOSE SURVIVORS; REDEFINITION; CONSENSUS; S-100B; CANCER;
D O I
10.1016/j.resuscitation.2013.01.031
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Aim: Use of brain biomarkers for predicting death after cardiopulmonary resuscitation (CPR) is limited by a research focus on the discriminative ability of each biomarker and ethical/cultural controversy concerning the likelihood of misclassification of potential survivors. We illustrate an approach to address these limitations by creating a dynamic nomogram with four levels of sensitivity (0.8, 0.9, 0.95 and 1.0) selected to represent different degrees of certainty in correct identification of survivors. Methods: A prolective observational study conducted in a single 850-bed hospital. Admission serum S100beta (S100B) and neuron-specific enolase (NSE) were determined for all adult survivors of non-traumatic out-of-hospital arrest and CPR. Results: 158 patients were included, 126 (80%) died in hospital, 32 (20%) survived. Non-survivors had higher admission biomarker levels than survivors (p <= 0.001 for both S100B and NSE). Presenting rhythm (VT/VF vs. other) and logarithmic-transformed S100B and NSE levels were statistically significant in the multivariable model predicting survival. The area under the model ROC curve was 0.868 (95% CI 0.80, 0.936). Plots for predicting survival for each combination of biomarker levels were generated for each sensitivity with and without VT/VF, allowing clinicians to select their option in terms of survival probability. In this modest-sized illustrative study the model misclassified 1/19 patients with Cerebral Performance Category 1-2 for sensitivity >0.80. Conclusions: We demonstrate how brain biomarkers can serve as decision support tools after CPR despite ethical/cultural differences in defining futility. Data from larger and diverse samples are required for stable estimates prior to clinical implementation of such a tool. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:1083 / 1088
页数:6
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