Data_Sheet_1_Serial S100B Sampling Detects Intracranial Lesion Development in Patients on Extracorporeal Membrane Oxygenation.zip

Introduction: Intracranial lesion development is a recognized complication in adults treated with extracorporeal membrane oxygenation (ECMO) and is associated with increased mortality. As neurological assessment during ECMO treatment remains challenging, protein biomarkers of cerebral injury could provide an opportunity to detect intracranial lesion development at an early stage. The aim of this study was to determine if serially sampled S100B could be used to detect intracranial lesion development during ECMO treatment.Methods: We conducted an observational cohort study of all patients treated with ECMO at ECMO Center Karolinska (Karolinska University Hospital, Stockholm, Sweden) between January and August 2018, excluding patients who did not undergo a computerized tomography scan (CT) during treatment. S100B was prospectively collected at hospital admission and then once daily. The primary end-point was any type of CT verified intracranial lesion. Receiver operating characteristics (ROC) curves and Cox proportional hazards models were employed.Results: Twenty-nine patients were included, of which 15 (52%) developed an intracranial lesion and exhibited higher levels of S100B overall. S100B had a robust association with intracranial lesion development, especially during the first 200 hours following admission. The best area-under-curve (AUC) to predict intracranial lesion development was 40 and 140 hours following ECMO initiation, were a S100B level of 0.69μg/L had an AUC of 0.81 (0.628-0.997). S100B levels were markedly increased following the development of intracranial hemorrhage.Conclusions: Serial serum S100B samples in ECMO patients were both significantly elevated and had an increasing trajectory in patients developing intracranial lesions. Larger prospective trials are warranted to validate these findings and to ascertain their clinical utility.

引言：脑内损伤的发展是接受体外膜肺氧合（ECMO）治疗的成年人常见的并发症，并与死亡率增加相关。由于在ECMO治疗期间进行神经学评估仍然具有挑战性，因此脑损伤的蛋白生物标志物可能为早期检测脑内损伤的发展提供了机遇。本研究的目的是确定连续采集的S100B是否可用于在ECMO治疗期间检测脑内损伤的发展。方法：我们在2018年1月至8月期间于Karolinska大学医院（斯德哥尔摩，瑞典）的ECMO中心对接受ECMO治疗的全部患者进行了一项观察性队列研究，排除了治疗期间未进行计算机断层扫描（CT）的患者。S100B在入院时及之后每日进行前瞻性收集。主要终点为任何类型的经CT证实的脑内损伤。使用了接收者工作特征（ROC）曲线和Cox比例风险模型。结果：共有29名患者被纳入研究，其中15名（52%）发生了脑内损伤，并且S100B的整体水平较高。S100B与脑内损伤的发展具有显著的相关性，尤其是在入院后最初的200小时内。预测脑内损伤发展的最佳曲线下面积（AUC）是在ECMO开始后40小时和140小时，此时S100B水平为0.69μg/L的AUC为0.81（95%置信区间为0.628-0.997）。在发生脑内出血后，S100B水平明显升高。结论：在ECMO患者中，连续血清S100B样本在发生脑内损伤的患者中不仅显著升高，且呈现上升趋势。需要更大规模的前瞻性试验来验证这些发现并确定其临床效用。