Elderly patients account for 80% of cardiac arrest patients. The incidence of poor neurological prognosis after return of spontaneous circulation of these patients is as high as 90%, much higher than that of young. This is related to the fact that the mechanism of hippocampal brain tissue injury after ischemia-reperfusion in elderly cardiac arrest patients is aggravated. Therefore, this study reviews the possible mechanisms of poor neurological prognosis after return of spontaneous circulation in elderly cardiac arrest animals, and the results indicate that the decrease of hippocampal perfusion and the number of neurons after resuscitation are the main causes of the increased hippocampal injury, among which oxidative stress, mitochondrial dysfunction and protein homeostasis disorder are the important factors of cell death. This review hopes to provide new ideas for the treatment of elderly patients with cardiac arrest and the improvement of neurological function prognosis through the comparative analysis of elderly and young animals.
Objective To explore the predictive value of superoxide dismutase (SOD) and serum amyloid A (SAA) in short-term poor prognosis in patients with lacunar infarction. Methods The clinical data of 185 patients who were diagnosed with lacunar infarction in the Second Affiliated Hospital of Wannan Medical College between January 1st and December 31st, 2021 were analyzed retrospectively. According to the modified Rankin Scale (mRS) score 3 months after discharge, the patients were divided into the good prognostic group (mRS≤2) and the poor prognostic group (mRS>2). Multiple logistic regression was used to analyze the independent risk factors of the short-term adverse prognosis of patients with lacunar infarction, and a risk prediction model (nomograph) was constructed. The predictive efficacy of SOD, SAA and nomograph for poor prognosis was analyzed by using the receiver operating characteristic curve. Calibration curve and decision curve analysis were used to evaluate the differentiation and clinical application value of the model. Results A total of 185 lacunar cerebral infarction patients with a mean age of (68.26±10.77) years were enrolled in this study, among whom 80 (43.2%) were males and 39 (21.1%) had adverse prognosis. Multiple logistic regression analysis showed that systolic blood pressure [odds ratio (OR)=1.028, 95% confidence interval (CI) (1.004, 1.052), P=0.021], diabetes [OR=4.939, 95%CI (1.703, 14.320), P=0.003], SAA [OR=1.089, 95%CI (1.052, 1.128), P<0.001], apolipoprotein B [OR=7.647, 95%CI (2.186, 26.753), P=0.001] were independent risk factors for poor prognosis in lacunar infarction patients, while the level of SOD [OR=0.979, 95%CI (0.965, 0.994), P=0.006] was a protective factor. The area under the curve of the nomograph for predicting the short term poor prognosis was 0.874 [95%CI (0.812, 0.936), P<0.001]. The goodness-of-fit test with the calibration curve indicated that the prediction probability was consistent with the actual occurrence probability (Hosmer-Lemeshow test P=0.295), and the decision curve indicated that the nomograph had good clinical application value. Conclusion SAA and SOD have good predictive value for short-term adverse prognosis of lacunar cerebral infarction patients, and the nomograph constructed based on them has a good differentiation and consistency, which can provide a basis for clinicians to evaluate the prognosis of lacunar cerebral infarction patients.