Wormsbecker Andrew, Sekhon Mypinder S, Griesdale Donald E, Wiskar Katie, Rush Barret
Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, 899 West 12th Avenue, University of British Columbia, Vancouver, BC, Canada V5Z 1M9.
Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, 899 West 12th Avenue, University of British Columbia, Vancouver, BC, Canada V5Z 1M9; Division of Critical Care Medicine, Department of Anaesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, West 12th Avenue, University of British Columbia, Vancouver, BC, Canada V5Z 1M9; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 899 West 12th Avenue, University of British Columbia, Vancouver, BC, Canada V5Z 1M9.
Resuscitation. 2017 Mar;112:11-16. doi: 10.1016/j.resuscitation.2016.12.010. Epub 2016 Dec 19.
To examine the relationship between daily mean hemoglobin concentration and neurological outcome in hypoxic ischemic brain injury (HIBI) following cardiac arrest.
We conducted a single center retrospective observational study using a database of HIBI patients between March 2009 and December 2014. We included all adults admitted to the intensive care unit following an in-hospital or out-of-hospital cardiac arrest. The primary outcome was neurological outcome measured by the Cerebral Performance Category (CPC) at hospital discharge. Multivariable logistic regression was used to analyze the association of mean hemoglobin concentration over 48h and 7 days after the onset of HIBI and discharge CPC. Favorable and unfavorable neurological outcome was dichotomized for a discharge CPC 1-2 vs 3-5, respectively.
118 patients were included in the analysis. Patients with a favorable neurological outcome had higher mean 7-day hemoglobin (115g/L vs 107g/L; p=0.05) compared to those with unfavorable outcome. Multivariate logistic regression controlling for age, time to return of spontaneous circulation and blood transfusion demonstrated that lower mean 48-h hemoglobin concentration was associated with unfavorable outcome (OR 0.69 per 10 unit change in Hgb, 95% CI 0.54-0.88, p<0.01). A repeated analysis using mean Hgb for the first 7 days yielded similar results for unfavorable outcome (OR 0.75 per 10 unit change in Hgb, 95% CI 0.57-0.97, p=0.03).
Lower mean hemoglobin concentration in the first 48h and 7 days following HIBI is associated with a higher odds of unfavorable outcome at hospital discharge. Further study to examine this association is warranted.
探讨心脏骤停后缺氧缺血性脑损伤（HIBI）患者每日平均血红蛋白浓度与神经功能预后之间的关系。
我们利用2009年3月至2014年12月期间HIBI患者的数据库进行了一项单中心回顾性观察研究。纳入所有因院内或院外心脏骤停后入住重症监护病房的成年人。主要结局是出院时通过脑功能分级（CPC）测量的神经功能预后。采用多变量逻辑回归分析HIBI发作后48小时和7天内平均血红蛋白浓度与出院时CPC的相关性。将良好和不良神经功能预后分别定义为出院时CPC为1 - 2级和3 - 5级。
118例患者纳入分析。与神经功能预后不良的患者相比，预后良好的患者7天平均血红蛋白水平更高（115g/L对107g/L；p = 0.05）。在控制年龄、自主循环恢复时间和输血因素的多变量逻辑回归分析中，48小时平均血红蛋白浓度较低与不良预后相关（血红蛋白每变化10个单位，OR为0.69，95%CI为0.54 - 0.88，p < 0.01）。对前7天平均血红蛋白进行重复分析，得出不良预后的结果相似（血红蛋白每变化10个单位，OR为0.75，95%CI为0.57 - 0.97，p = 0.03）。
HIBI后最初48小时和7天内平均血红蛋白浓度较低与出院时不良预后的几率较高相关。有必要进一步研究以探讨这种关联。
