Highlights
- •We evaluated prognostic predictors in out-of-hospital cardiac arrest patients.
- •The 30-day mortality was associated with simple clinical parameters.
- •We proposed an equation for predicting the estimated probability of death (EPD).
- •The EPD may help consider further best support for these patients.
Abstract
Background
Early prediction of outcomes after cardiopulmonary arrest (CPA) is important for considering
the best support. Our purpose was to evaluate predictors of the 30-day mortality in
patients with CPA after return of spontaneous circulation (ROSC) and to assess an
equation for calculating the 30-day mortality using clinical parameters.
Methods
We retrospectively analyzed the data of 194 consecutive patients with CPA and ROSC
in a derivation study (2015–2022). We compared clinical parameters between the survived
(n = 78) and dead (n = 116) patients. We derived an equation for estimated probability of death based
on clinical parameters, using multivariate logistic regression analysis. The reliability
of the equation was validated in 80 additional patients with CPA.
Results
The 30-day mortality was associated with sex, witnessed cardiac arrest, bystander
cardiopulmonary resuscitation (CPR), CPA due to acute myocardial infarction, pupil
diameter, Glasgow Coma Scale score (GCS), presence of light reflex, arterial or venous
pH, lactate levels, initial ventricular fibrillation (VF), CPA time, and age. The
derived logistic regression equation was as follows: Estimated probability of death = 1
/ (1 + e-x), x = (0.25 × bystander CPR) + (0.44 × pupil diameter) – (0.14 × GCS) + (0.09 × lactate)
– (1.87 × initial VF) + (0.07 × CPA time) + (0.05 × age) - 7.03. The cut-off value
for estimated probability of death calculated by this equation was 54.5 %, yielding
a sensitivity, specificity, and accuracy of 86.2 %, 80.8 %, and 84.5 %, respectively.
In the validation model, these values were 81.8 %, 85.7 %, and 82.5 %, respectively.
Conclusions
The 30-day mortality may be calculated after ROSC in patients with CPA using simple
clinical parameters. This equation may facilitate further best support for patients
with CPA.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 01, 2023
Accepted:
January 2,
2023
Received in revised form:
November 22,
2022
Received:
December 31,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
