Cour Martin, Bresson Didier, Hernu Romain, Argaud Laurent
Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, F-69437 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, F-69373 Lyon, France; INSERM, U1060 CarMeN, F-69373 Lyon, France.
Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, F-69437 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, F-69373 Lyon, France.
Resuscitation. 2016 May;102:110-5. doi: 10.1016/j.resuscitation.2016.03.001. Epub 2016 Mar 7.
The aim of the study was to assess the prognostic impact of organ failures at ICU admission after out-of-hospital cardiac arrest (CA) according to the SOFA score.
We performed a retrospective analysis of a prospective cohort of all adult patients admitted to a 15-bed medical ICU in a university-affiliated hospital after an out-of-hospital CA. In addition to demographic and clinical data, initial illness severity was measured using the SOFA score. Outcomes (mortality and neurological prognosis) were also collected at day 28 and one year.
A total of 304 patients (age: 66±16 years, male: 55%) were admitted for post-CA management. An initial nonshockable cardiac rhythm was recorded in 274 (90%) cases. At admission, SOFA score averaged 9.8±3.1 for the entire cohort (8.1±3.3 for day 28 survivors versus 10.1±3.1 for non-survivors, p<0.001). At day 1, SOFA remained significantly (p<0.001) higher in nonsurvivors (9.8±3.8) when compared to survivors (6.5±4.1). Death occurred in 269 (88%) and 275 (90%) patients within the 28-day and one-year period, respectively. Neurological outcome at one year was favorable (CPC score 1-2) in 23patients (8%). Multivariate analysis identified the SOFA score at admission as independently associated with mortality at day28 (OR per point of SOFA score 1.17; 95% CI 1.01-1.35; p=0.03).
In the present study, early organ failures, as assessed by the SOFA score at ICU admission, were independently associated with day 28 mortality. SOFA score may help clinicians objectively evaluate the severity of the post-CA syndrome.
本研究旨在根据序贯器官衰竭评估（SOFA）评分，评估院外心脏骤停（CA）后入住重症监护病房（ICU）时器官衰竭对预后的影响。
我们对一所大学附属医院中15张床位的内科ICU收治的所有成年院外CA患者的前瞻性队列进行了回顾性分析。除人口统计学和临床数据外，使用SOFA评分衡量初始疾病严重程度。在第28天和1年时还收集了结局（死亡率和神经学预后）。
共有304例患者（年龄：66±16岁，男性：55%）因CA后管理入院。274例（90%）病例记录到初始不可电击心律。入院时，整个队列的SOFA评分平均为9.8±3.1（第28天存活者为8.1±3.3，非存活者为10.1±3.1，p<0.001）。在第1天，非存活者的SOFA评分（9.8±3.8）仍显著高于存活者（6.5±4.1）（p<0.001）。分别有269例（88%）和275例（90%）患者在28天和1年期间死亡。1年后23例患者（8%）的神经学结局良好（CPC评分1 - 2）。多因素分析确定入院时的SOFA评分与第28天的死亡率独立相关（SOFA评分每增加1分的比值比为1.17；95%置信区间1.01 - 1.35；p = 0.03）。
在本研究中，根据ICU入院时的SOFA评分评估，早期器官衰竭与第28天死亡率独立相关。SOFA评分可能有助于临床医生客观评估CA后综合征的严重程度。
