Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
Resuscitation. 2013 Jan;84(1):48-53. doi: 10.1016/j.resuscitation.2012.09.003. Epub 2012 Sep 11.
We sought to investigate the prognostic implication of early coagulopathy represented by initial DIC score in out-of-hospital cardiac arrest (OHCA).
OHCA registry was analyzed to identify patients with ROSC without recent use of anticoagulant between 2008 and 2011. Patients were assessed for prehosptial factors, initial laboratory results and therapeutic hypothermia. Outcome variables were survival discharge, 6-month CPC and survival duration within the first week after ROSC. Logistic regression and Cox proportional hazards models were used for both univariable and multivariable analysis.
Among 273 eligible patients, initial DIC score was available in 252 (92.3%). Higher DIC score was associated with increased inhospital death (odds ratio [OR], 1.89 per unit; 95% confidence interval [CI], 1.48-2.41) and unfavorable long-term outcome (6-month CPC 3-5; OR, 2.21 per unit; 95% CI, 1.60-3.05). The adjusted ORs for both outcomes were 1.61 (95% CI, 1.17-2.22) and 1.84 (95% CI, 1.26-2.67), respectively. We categorized DIC score in five groups as <3, 3, 4, 5 and >5 and analyzed differential mortality risk using Cox proportional hazards model. Compared with reference group (DIC score<3), the adjusted HR for early mortality in each remaining group was 1.96 (95% CI, 1.13-3.40), 2.26 (95% CI, 1.27-4.02), 2.77 (95% CI, 1.58-4.85) and 4.29 (95% CI, 2.22-8.30), respectively (p-trend<0.001). The area under the receiver operating characteristic of DIC score for prediction of unfavorable long-term outcome was 0.79 (95% CI, 0.69-0.88).
Increased initial DIC score in OHCA was an independent predictor for poor outcomes and early mortality risk.
本研究旨在探讨院外心脏骤停（OHCA）患者早期弥散性血管内凝血（DIC）评分对预后的影响。
本研究分析了 2008 年至 2011 年期间 ROSC 后未使用抗凝剂的 OHCA 患者的注册资料。评估了患者的院前因素、初始实验室结果和亚低温治疗情况。预后变量包括存活出院、6 个月的 CPC 评分和 ROSC 后第一周的存活时间。采用单变量和多变量分析的逻辑回归和 Cox 比例风险模型。
在 273 名符合条件的患者中，252 名（92.3%）患者的初始 DIC 评分可用。较高的 DIC 评分与院内死亡率增加（优势比[OR]，每单位增加 1.89；95%置信区间[CI]，1.48-2.41）和不良长期预后（6 个月 CPC 3-5 分；OR，每单位增加 2.21；95% CI，1.60-3.05）相关。两个结局的调整 OR 分别为 1.61（95% CI，1.17-2.22）和 1.84（95% CI，1.26-2.67）。我们将 DIC 评分分为<3、3、4、5 和>5 五个组，并使用 Cox 比例风险模型分析了不同的死亡率风险。与参考组（DIC 评分<3）相比，其余各组的早期死亡率调整 HR 分别为 1.96（95% CI，1.13-3.40）、2.26（95% CI，1.27-4.02）、2.77（95% CI，1.58-4.85）和 4.29（95% CI，2.22-8.30）（p 趋势<0.001）。DIC 评分预测不良长期预后的受试者工作特征曲线下面积为 0.79（95% CI，0.69-0.88）。
OHCA 患者初始 DIC 评分升高是预后不良和早期死亡风险的独立预测因素。
