Aims

To identify plasma biomarkers associated with cardiac arrest in a cohort of children with acute respiratory distress syndrome (ARDS), and to assess the association of these biomarkers with mortality in children with cardiac arrest and ARDS (ARDS + CA).

Methods

This was a secondary analysis of a single-center prospective cohort study of children with ARDS from 2014-2019 with 17 biomarkers measured. Clinical characteristics and biomarkers were compared between subjects with ARDS + CA and ARDS with univariate analysis. In a sub-cohort of ARDS + CA subjects, the association between biomarker levels and mortality was tested using univariate and bivariate logistic regression.

Results

Biomarkers were measured in 333 subjects: 301 with ARDS (median age 5.3 years, 55.5% male) and 32 ARDS + CA (median age 8 years, 53.1% male). More arrests (69%) occurred out-of-hospital with a median CPR duration of 11 (IQR 5.5, 25) minutes. ARDS severity, PRISM III score, vasoactive-ionotropic score and extrapulmonary organ failures were worse in the ARDS + CA versus ARDS group. Eight biomarkers were elevated in the ARDS + CA versus ARDS cohort: sRAGE, nucleosomes, SP-D, CCL22, IL-6, HSP70, IL-8, and MIP-1b. sRAGE, SP-D, and CCL22 remained elevated when the cohorts were matched for illness severity. When controlling for severity of ARDS and cardiac arrest characteristics, sRAGE, IL-6 and granzyme B were associated with mortality in the ARDS + CA group.

Conclusion

sRAGE, IL-6 and granzyme B were associated with cardiac arrest mortality when controlling for illness severity. sRAGE was consistently higher in the ARDS + CA cohort compared to ARDS and retained independent association with mortality.

中文翻译：

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与心脏骤停和急性呼吸窘迫综合征儿科患者死亡率相关的生物标志物

宗旨

在一组患有急性呼吸窘迫综合征 (ARDS) 的儿童中鉴定与心脏骤停相关的血浆生物标志物，并评估这些生物标志物与心脏骤停和 ARDS (ARDS + CA) 儿童死亡率的关联。

方法

这是对 2014-2019 年 ARDS 儿童的单中心前瞻性队列研究的二次分析，其中测量了 17 种生物标志物。通过单变量分析比较 ARDS + CA 和 ARDS 受试者的临床特征和生物标志物。在 ARDS + CA 受试者的子队列中，使用单变量和双变量逻辑回归测试生物标志物水平与死亡率之间的关联。

结果

在 333 名受试者中测量了生物标志物：301 名患有 ARDS（中位年龄 5.3 岁，55.5% 男性）和 32 名 ARDS + CA（中位年龄 8 岁，53.1% 男性）。更多的心脏骤停 (69%) 发生在院外，中位 CPR 持续时间为 11 (IQR 5.5, 25) 分钟。ARDS 严重程度、PRISM III 评分、血管活性-离子型评分和肺外器官衰竭在 ARDS + CA 组比 ARDS 组更差。与 ARDS 队列相比，ARDS + CA 队列中有八种生物标志物升高：sRAGE、核小体、SP-D、CCL22、IL-6、HSP70、IL-8 和 MIP-1b。当队列与疾病严重程度相匹配时，sRAGE、SP-D 和 CCL22 仍然升高。当控制 ARDS 的严重程度和心脏骤停特征时，sRAGE、IL-6 和颗粒酶 B 与 ARDS + CA 组的死亡率相关。

结论

在控制疾病严重程度时，sRAGE、IL-6 和颗粒酶 B 与心脏骤停死亡率相关。与 ARDS 相比，ARDS + CA 队列中的 sRAGE 始终较高，并且与死亡率保持独立关联。