Changes And Clinical Significance Of Ischemia Modified Albumin In Patients With Cardiopulmonary Resuscitation

Background: Cardiac arrest is a sudden termination of cardiac ejection result from avariety of causes. At present, the main treatment of cardiac arrest is cardiopulmonaryresuscitation (CPR). Patients with cardiac arrest often have very poor prognosis.Therefore, early understanding of CPR prognosis in patient with cardiac arrest isparticularly important. Studies have shown that ischemia modified albumin (IMA)may be a predictor of reaching restoration of spontaneous circulation(ROSC) forpatients with cardiac arrest after CPR..Objective: To understand the changes of the level of oxidative stress and serum IMA inpatients with cardiac arrest after CPR, and explore the value of serum IMA in predictingprognosis of these patients after CPR.Methods:(1) A totol of36participants (25men and11women) with cardiac arrest after CPR wererecruited into experimental group(group C).Among them,15cases (11men and4women)and21cases (14men and7women) are respectively divided into the resuscitation group(group R) and non resuscitation group(group NR) according to the condition of ROSC.Meanwhile, a totol of60healthy participants (39men and21women) matched for ageand gender were recruited into healthy control group (group H).(2)We collected the serum of patients in group C at the beginning of CPR (within5min)in combination with that in group H, and measured the index of oxidative stress,namely the level of malondialdehyde (MDA), superoxide dismutase (SOD) andglutathione peroxidase (GSH-Px). At last, the changes of serum oxidative stress indexbetween groups were analysed.(3)We performed the determination of the serum IMA level, and analysed the changesof serum IMA between groups. Results:(1) Compared with group H (P<0.05), participants in group C had higher serum MDAlevel (P<0.05)and lower level of SOD and GSH-Px (P<0.05for both); The levels ofserum MDA in group NR and group R were higher than that in group H (P<0.05).Serum SOD, GSH-Px levels were lower than that in group H (P<0.05for both), butthere were no statistical differences between group NR and group R in serum MDA,SOD, GSH-Px levels (P>0.05for all).(2) The level of serum IMA in group C were higher than that in group H (P<0.05); Theserum IMA level in group R was lower than that in group NR and higher than that ingroup H (P<0.05for both).(3) The area under the ROC curve for serum IMA in predicting the prognosis of patientswith cardiac arrest after CPR is0.73. When the Cut off value is128.25U/ml, thesensitivity and specificity are57.1%and93.3%respectively; the positive predictivevalue and negative predictive value are92.3%and60.9%; positive likelihood ratio andnegative likelihood ratio are8.5and0.5; the correct diagnosis index is72.2%, andYouden index is50.5%.(4) There was no correlation between the serum IMA level and the changes of serumMDA, SOD and GSH-Px level in group C (P>0.05for all).Conclusion:(1) Patients with cardiac arrest after CPR occurred a serious oxidative stress reaction,which may be an important reason which lead to poor prognosis of patients with cardiacarrest after CPR. But the related oxidative stress index can’t be used for the predictionof prognosis in cardiac arrest patient after CPR..(2) Serum IMA has a certain value in prediction of prognosis in patients with cardiacarrest after CPR.(3) Serum IMA level rised after CPR in the patients with cardiac arrest, but thecorrelation between its increase and changes of the serum oxidative stress index is stillunclear. And further studies are needed to confirm it.