Development of a prompt model for predicting neurological outcomes in patients with return of spontaneous circulation from out-of-hospital cardiac arrest.

Aim: Early prediction of the neurological outcomes of patients with out-of-hospital cardiac arrest is important to select the optimal clinical management. We hypothesized that clinical data recorded at the site of cardiopulmonary resuscitation would be clinically useful. Methods: This retrospective cohort study included patients with return of spontaneous circulation after cardiopulmonary resuscitation who were admitted to our university hospital between January 2000 and November 2013 or two affiliated hospitals between January 2006 and November 2013. Clinical parameters recorded on arrival included age (A), arterial blood pH (B), time from cardiopulmonary resuscitation to return of spontaneous circulation (C), pupil diameter (D), and initial rhythm (E). Glasgow Outcome Scale was recorded at 6 months and a favorable neurological outcome was defined as a score of 4-5 on the Glasgow Outcome Scale. Multiple logistic regression analysis was carried out to derive a formula to predict neurological outcomes based on basic clinical parameters. Results: The regression equation was derived using a teaching dataset (total, n = 477; favourable outcome, n = 55): EP = 1/(1 + e-x ), where EP is the estimated probability of having a favorable outcome, and x = (-0.023 × A) + (3.296 × B) - (0.070 × C) - (1.006 × D) + (2.426 × E) - 19.489. The sensitivity, specificity, and accuracy were 80%, 92%, and 90%, respectively, for the validation dataset (total, n = 201; favourable outcome, n = 25). Conclusion: The 6-month neurological outcomes can be predicted in patients resuscitated from out-of-hospital cardiac arrest using clinical parameters that can be easily recorded at the site of cardiopulmonary resuscitation.

Synchronized changes in serum vascular endothelial growth factor during the clinical course of chronic systemic capillary leak syndrome.

Systemic capillary leak syndrome (SCLS) is a rare disease characterized by leakage of plasma from blood vessels into the interstitial space due to increased capillary permeability. We describe a 24-year-old man who was hospitalized with systemic edema, hypoalbuminemia, and disseminated intravascular coagulation. After extensive investigative procedures, he was diagnosed with chronic SCLS and made a gradual recovery after starting on prednisolone, terbutaline, and theophylline. We measured the patient's serum vascular endothelial growth factor (VEGF) over time and found a relationship between serum VEGF and the clinical course.

Moderate hypothermia suppressed excessive generation of superoxide anion radical and inflammatory reactions in blood and liver in heatstroke: laboratory study in rats.

Abstract The study was performed to demonstrate superoxide radical (O(2).-) generation, systemic inflammation and liver injury caused by heatstroke and to reveal suppressive effects of moderate hypothermia. Heatstroke was defined as achieving pharyngeal temperature of 40 degrees C with arterial pressure reduction. Heatstroke rats were divided to four groups by the temperature after the onset; 40 degrees C, 37 degrees C, 32 degrees C and sham-treated with 37 degrees C. O(2).- current was measured continuously in the right atrium using an electrochemical O(2).- sensor. The O(2).- current increased in all groups except for the sham-treated group during the induction. After the onset of heatstroke, the O(2).- current was suppressed with temperature-dependency. Plasma and liver high-mobility group box 1, intercellular adhesion molecule-1, plasma aspartate aminotransferase and alanine aminotransferase were also suppressed with the suppression of O(2).- generation. Therefore, excessive O(2).- generation might be a key factor in heatstroke and the suppression with moderate hypothermia would be a therapeutic modality.

Comparison of the predictability of neurological outcome by serum procalcitonin and glial fibrillary acidic protein in postcardiac-arrest patients.

BACKGROUND: In past research, procalcitonin (PCT) and glial fibrillary acidic protein (GFAP) have been reported to be useful biomarkers in predicting neurological outcome after the return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (CA), although they have only been studied separately. In this study, we compared the usefulness of PCT and GFAP in predicting neurological outcome. METHODS: This study was a retrospective, single-center analysis, conducted in the intensive-care unit of a university hospital. Twenty-one sequential post-CA patients were included. Serum samples were collected from patients at 12 and 24 h after ROSC. Serum PCT and GFAP were measured and compared in patients with favorable and unfavorable neurological outcomes, evaluated at 6 months using the Glasgow-Pittsburgh Cerebral Performance Categories. RESULTS: Serum PCT was significantly higher at 12 and 24 h in patients with unfavorable outcomes (P = 0.004 and 0.002, respectively). Serum GFAP was not significantly higher at 12 and 24 h in patients with unfavorable outcomes (P = 0.118 and 0.079, respectively). The combination of PCT and GFAP showed high predictive value for unfavorable outcomes (86.7% sensitivity and 100% specificity at 12 h; 100% sensitivity and 83.3% specificity at 24 h). CONCLUSION: Serum PCT is a marker of unfavorable neurological outcome in post-CA patients, and is superior to serum GFAP in the early phase.

Increase in plasma glucagon, a factor in hyperglycemia, is related to neurological outcome in postcardiac-arrest patients.

AIM OF THE STUDY: In postcardiac-arrest (PCA) patients, hyperglycemia is a factor reflecting an unfavorable outcome, and might be caused by the inflammation and stress of "sepsis-like" syndrome. In this study, plasma glucagon, a representative glycogenolytic and gluconeogenic hormone, was measured and assessed the correlation for neurological outcome in PCA patients. METHODS: This study was a retrospective, single-medical-center analysis, conducted in the intensive care unit of a university hospital. Twenty-four sequential PCA patients were included. Plasma samples were collected from the patients on days 1, 2, and 3 after the return of spontaneous circulation (ROSC). Glucagon was compared in patients with favorable and unfavorable neurological outcomes. RESULTS: At all time points, plasma glucagon was significantly higher in patients with an unfavorable outcome (P<0.05). Glucagon on day 1 had remarkable sensitivity (88.2%) and specificity (85.8%) as an indicator of outcome, and correlated with the collapse-ROSC interval, the start of cardiopulmonary resuscitation (CPR)-ROSC interval, and the epinephrine dose during CPR. CONCLUSIONS: Plasma glucagon reflects unfavorable outcomes in PCA patients, and might be related to ischemic and reperfusion stress.