Background

Evaluate the accuracy of brain-based blood biomarkers neuron-specific enolase (NSE) and S100b and electroencephalography (EEG) features alone and in combination with prognosticate 6-month mortality after pediatric cardiac arrest. We hypothesized that the combination of blood brain-based biomarkers and EEG features would have superior classification accuracy of outcome versus either alone.

Methods

Children (n = 58) aged between 1 week and 17 years admitted to the ICU following cardiac arrest at a tertiary care children's hopital were eligible for this secondary study. Blood NSE and S100b were measured closest to 24 hours after return of spontaneous circulation (ROSC). EEGs closest to 24 hours (median 11, interquartile range [IQR] 6 to 16 h) post-ROSC were evaluated by two epileptologists. EEG grade was informed by background frequency, amplitude, and continuity. Sleep spindles were present or absent. Mortality was assessed at six months post-ROSC. Area under the receiver operator curve (AUC) was performed for individual and combined brain-based biomarkers and EEG features.

Results

Children were aged 2.6 (IQR 0.6 to 10.4) years, and 25 (43%) died. Children who died had increased blood NSE (49.7 [28.0 to 63.1] vs 18.2 [9.8 to 31.8] ng/mL) and S100b (0.118 [0.036 to 0.296] vs 0.012 [0.003 to 0.021] ng/mL) and poor (discontinuous or isoelectric) EEG grade (76% vs 33%) more frequently than survivors (P < 0.05). AUC for NSE to predict mortality was 0.789, and was 0.841 when combined with EEG grade and spindles. S100b AUC for mortality was 0.856 and was optimal alone.

Conclusions

In this exploratory study, the combination of brain-based biomarkers and EEG features may provide more accurate prognostication than either test alone after pediatric cardiac arrest.

中文翻译：

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脑电图和基于血液的脑损伤生物标志物准确性与预测儿科心脏骤停后死亡率的关联：一项探索性研究

背景

单独评估基于大脑的血液生物标志物神经元特异性烯醇化酶 (NSE) 和 S100b 以及脑电图 (EEG) 特征的准确性，并结合预测儿科心脏骤停后 6 个月的死亡率。我们假设基于血脑的生物标志物和脑电图特征的组合将比单独使用任何一种具有更高的结果分类准确性。

方法

在三级护理儿童医院心脏骤停后入住 ICU 的 1 周至 17 岁的儿童 (n = 58) 有资格参加这项次要研究。在自主循环 (ROSC) 恢复后最接近 24 小时测量血液 NSE 和 S100b。两位癫痫专家评估了 ROSC 后最接近 24 小时（中位数 11，四分位距 [IQR] 6 至 16 小时）的 EEG。EEG 等级由背景频率、幅度和连续性决定。存在或不存在睡眠纺锤体。在 ROSC 后 6 个月评估死亡率。针对个体和组合的基于脑的生物标志物和脑电图特征进行接受者操作曲线下面积 (AUC)。

结果

儿童年龄为 2.6（IQR 0.6 至 10.4）岁，25 人（43%）死亡。死亡儿童的血液 NSE 升高（49.7 [28.0 至 63.1] vs 18.2 [9.8 至 31.8] ng/mL）和 S100b（0.118 [0.036 至 0.296] vs 0.012 [0.003 至 0.021] ng/mL）和差（不连续或等电）EEG 分级（76% vs 33%）比幸存者更频繁（P  < 0.05）。NSE 预测死亡率的 AUC 为 0.789，与 EEG 分级和纺锤体相结合时为 0.841。死亡率的 S100b AUC 为 0.856，单独使用时最佳。

结论

在这项探索性研究中，基于大脑的生物标志物和脑电图特征的结合可能比儿童心脏骤停后单独的任何一项测试提供更准确的预后。