Potpara Tatjana S, Mihajlovic Miroslav, Stankovic Sanja, Jozic Tanja, Jozic Irena, Asanin Milika R, Ahmad Rajai, Lip Gregory Y H
Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Belgrade, Serbia.
School of Medicine, Belgrade University, Belgrade, Serbia.
Am J Med. 2017 Dec;130(12):1464.e13-1464.e21. doi: 10.1016/j.amjmed.2017.05.035. Epub 2017 Jun 21.
Rapid clinical decision-making on further management of patients with out-of-hospital cardiac arrest may be challenging. Recently, a "futility" score (NULL-PLEASE) incorporating multiple adverse resuscitation features (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood PH <7.2, Lactate >7.0 mmol/L, End-stage chronic kidney disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) has been proposed to help identify patients with out-of-hospital cardiac arrest unlikely to survive; however, external independent score validation is lacking.
We retrospectively validated the NULL-PLEASE predictive ability for early in-hospital outcome of out-of-hospital cardiac arrest in a single-center cohort of 547 consecutive patients with out-of-hospital cardiac arrest who were admitted from April 2013 to October 2016 (mean age, 66.3 ± 13.2 years); 227 patients (41.5%) died. Because pH and lactate were inconsistently measured, a modified NULL-PLEASE score excluding both variables was calculated as the principal analysis. A sensitivity analysis included the subgroup with pH data available (n = 177).
Long low-flow period and age ≥85 years were independently associated with fatal outcome (both P < .001). Patients with a modified NULL-PLEASE score of ≥5 had a 3.3-fold greater risk of fatal outcome compared with a score of 0 to 4 (odds ratio, 3.34; 95% confidence interval [CI], 2.29-4.89; P < .001); 77% of nonsurvivors had a score ≥5; NULL-PLEASE showed a modest predictive ability for fatal outcome (c-statistic 0.658; 95% CI, 0.613-0.704; P < .001). Sensitivity analysis yielded similar results, with 88% of nonsurvivors having a score ≥5.
The NULL-PLEASE score was predictive for early in-hospital outcome of out-of-hospital cardiac arrest, with a 3.3-fold greater odds for fatal outcome at the score values of ≥5.
对院外心脏骤停患者的进一步治疗进行快速临床决策可能具有挑战性。最近，一种“无意义”评分（NULL-PLEASE）被提出，该评分纳入了多个不良复苏特征（不可电击心律、未被目击的心脏骤停、长无血流或长低血流期、血液pH值<7.2、乳酸>7.0 mmol/L、透析中的终末期慢性肾病、年龄≥85岁、仍在进行复苏以及心外原因），以帮助识别不太可能存活的院外心脏骤停患者；然而，缺乏外部独立的评分验证。
我们回顾性验证了NULL-PLEASE对2013年4月至2016年10月收治的547例连续院外心脏骤停患者（平均年龄66.3±13.2岁）的院内早期结局的预测能力；227例患者（41.5%）死亡。由于pH值和乳酸的测量不一致，计算了一个排除这两个变量的改良NULL-PLEASE评分作为主要分析。敏感性分析包括有pH值数据的亚组（n = 177）。
长低血流期和年龄≥85岁与致命结局独立相关（均P <.001）。改良NULL-PLEASE评分≥5的患者与评分为0至4的患者相比，致命结局风险高3.3倍（比值比，3.34；95%置信区间[CI]，2.29 - 4.89；P <.001）；77%的非幸存者评分≥5；NULL-PLEASE对致命结局显示出适度的预测能力（c统计量0.658；95% CI，0.613 - 0.704；P <.001）。敏感性分析得出类似结果，88%的非幸存者评分≥5。
NULL-PLEASE评分可预测院外心脏骤停患者的院内早期结局，评分≥5时致命结局的几率高3.3倍。
