Samu 44, Department of Emergency Medicine, University Hospital of Nantes, France; University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances (MiHAR), Nantes, France.
University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances (MiHAR), Nantes, France; Department of Epidemiology and Medical Evaluation, University Hospital of Nantes, France.
Resuscitation. 2018 Jun;127:8-13. doi: 10.1016/j.resuscitation.2018.03.020. Epub 2018 Mar 12.
Loss of pupillary light reactivity (PLR) three days after a cardiorespiratory arrest is a prognostic factor. Its predictive value upon hospital admission remains unclear. Our objective was to determine the prognostic value of the absence of PLR upon hospital admission in patients with out-of-hospital cardiac arrest.
We prospectively included all out-of-hospital cardiac arrests occurring between July 2011 and July 2017 treated by a mobile medical team (MMT) based on data from a French cardiac arrest registry database. PLR was evaluated upon hospital admission and the outcome on day 30. The prognosis was classified as good for Cerebral Performance Category (CPC) 1 or 2, and poor for CPC 3-5 or in case of death.
Data from 10151 patients was analysed. The sensitivity and specificity of the absence of PLR for a poor outcome were 72.2% (71.2-73.2) and 68.8% (66.7-70.1), respectively. We identified several variables modifying the sensitivity values and the false positive fraction of a factor, ranging from 0.49 (0.35-0.69) for the Glasgow Coma Scale to 2.17 (1.09-2.48) for pupillary asymmetry. Among those living with CPC 1 or 2 on day 30 (n = 1990; 19.6%), 621 (31.2% (29.2-33.3)) had no PLR upon hospital admission. In the multivariate analysis, loss of PLR was associated with a poor outcome (OR = 3.1 (2.7-3.5)).
Loss of pupillary light reactivity upon hospital admission is predictive of a poor outcome after out-of-hospital cardiac arrest. However, it does not have sufficient accuracy to determine prognosis and decision making.
心搏骤停后三天瞳孔光反射消失（PLR）是一个预后因素。其入院时的预测价值尚不清楚。我们的目的是确定院外心脏骤停患者入院时 PLR 缺失的预后价值。
我们前瞻性地纳入了 2011 年 7 月至 2017 年 7 月期间由基于法国心脏骤停登记数据库的移动医疗团队（MMT）治疗的所有院外心脏骤停患者。入院时评估 PLR，并在第 30 天评估结局。预后分类为良好（Cerebral Performance Category，CPC）1 或 2，不良（CPC 3-5 或死亡）。
共分析了 10151 例患者的数据。PLR 缺失对不良结局的敏感性和特异性分别为 72.2%（71.2-73.2）和 68.8%（66.7-70.1）。我们发现了几个变量会改变敏感性值和假阳性率，范围从格拉斯哥昏迷量表的 0.49（0.35-0.69）到瞳孔不对称的 2.17（1.09-2.48）。在第 30 天存活并具有 CPC 1 或 2 的患者中（n=1990；19.6%），621 例（31.2%（29.2-33.3））入院时无 PLR。多变量分析显示，PLR 缺失与不良结局相关（OR=3.1（2.7-3.5））。
院外心脏骤停后入院时瞳孔光反射消失预测预后不良。然而，它的准确性不足以确定预后和决策。
