Study of prognostic values of soluble selectins E and P in successfully resuscitated children after cardiopulmonary arrest

ABSTRACT

Successful resuscitation of children with cardiopulmonary arrest [CPA] is often complicated by postresuscitation state related to ischemiaireperfusion injury. Studies demonstrated increase in release of soluble intercellular adhesion molecules including soluble E- and soluble P-selectins [sE- and sPselectins] during and after cardiopulmonary resuscitation [CPR]. Therefore, this study was carried out to analyze the relationship between plasma levels of sE- and sP-selectins in successfully resuscitated children after CPA and their outcome. Plasma levels of sE-and sP-selectin were measured 24 hrs after successful resuscitation of 65 children with CPA. Forty five [69.23%] patients out of 65 developed SIRS in the second day after CPR. Patients with SIRS had non significantly higher sE-selectin levels [95.58 +/- 32.38 ng/ml] than patients without SIRS [88.17 +/- 28.25 ng/ml] [p =0.67]. The mean value of sE-selectin was not significantly higher in patients with sepsis [96.53 +/- 30.62 ng/ml] than in patients without sepsis [89.39 +/- 27.57 ng/ml] [p = 0.48]. The mean value of sE-selectin was significantly higher in non survivors [147.65 +/- 43.64 ng/ml] than in survivors [87.63 +/- 25.89 ng/ml] [p <0.01]. Patients with SIRS had significantly higher sP-selectin levels [187. 12 +/- 64. 75 ng/ml] than patients without SIRS [100.42 +/- 33.70 ng/ml] [p =0.005]. The mean value of sP-selectin was significantly higher in patients with sepsis [172.40 +/- 54.43 ng/ml] than in patients without sepsis [105.60 +/- 34.35 ng/ml] [p =0.015]. The mean value of sP-selectin was not significantly higher in survivors [217.75 +/- 72.08 ng/ml] than in non survivors [175.69 +/- 51.43 ng/ml] [p = 0.175]. The total non survival was 57 [87.69%] patients. Cerebral performance at hospital discharge was good in 3 out-of 8 patients [37.5%] and unfavorable in 5 [62.5%] patients. sE-selectin had higher sensitivity [94.87%] and specificity [85.33%] in the prediction of non survival with an area under the ROC curve [95% CI] of 0.95 [0.84-0.99] and a cut-off value of 136 ng/ml. sP-selectin had higher sensitivity [87.50%] and specificity [96.55%] in the prediction of sepsis with an area under the ROC curve [95% CI] of 0.96 [0.86-0.99] and a cut-off value of 159 ng/ml. Successful CPR after cardiac arrest is associated with increase in sE- and sP-selectin and high incidence of SIRS. Estimation of sE-selectin may help detection of patients with high risk of poor outcome while estimation of sP-selectin may predict those with high risk for sepsis