Decreased a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 activity and neurologic outcome in patients with successful resuscitation of out-of-hospital cardiac arrest: A prospective observational study

作者：Ohbe Hiroyuki; Kudo Daisuke^*; Yamanouchi Satoshi; Kushimoto Shigeki

来源：Journal of Critical Care, 2017, 37: 13-18.

DOI：10.1016/j.jcrc.2016.08.011

• ADAMTS13
• Out-of-hospital cardiac arrest
• Postcardiac arrest syndrome
• Neurologic outcome

Purpose: The purpose of this study is to investigate the association between a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13) and neurologic outcome in patients with resuscitation of out-of-hospital cardiac arrest (R-OHCA).
Materials and Methods: A prospective observational study of adult patients with R-OHCA was conducted. Plasma activity of ADAMTS13 and inflammatory markers, an immunologic marker, and a marker of endothelial damage were measured on admission and day 2. Neurologic outcome was evaluated using the Cerebral Performance Categories on day 90.
Results: Plasma activity of ADAMTS13 on day 2 was lower in patients with poor neurologic outcome (n = 18) than that in those with good neurologic outcome (n= 16; P =.008). It was also lower in 28-day nonsurvivors (n = 12) than in survivors (n = 21; P =.019). Soluble thrombomodulin showed a strong correlation with ADAMTS13 (P -.021). Furthermore, ADAMTS13 activity was negatively correlated with the Sequential Organ Failure Assessment score (P <.001), levels of high-mobility group box 1 (P =.028), and levels of interleukin 6 (P =.047) but positively correlated with the monocyte expression of human leukocyte antigen DR (P =.023).
Conclusion: Decreased ADAMTS13 activity was associated with poor neurologic outcome, high mortality, and worsened immune-inflammatory status in patients with R-OHCA. These results suggest that ADAMTS13 may have pathophysiologic relevance in postcardiac arrest syndrome.

• 出版日期2017-2