Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
Shock. 2020 Apr;53(4):442-451. doi: 10.1097/SHK.0000000000001405.
We aimed to evaluate the lactate/albumin ratio (LAR) to identify its significance as a prognostic marker for favorable neurologic outcome and survival in patients with return of spontaneous circulation after out-of-hospital cardiac arrest (OHCA). Based on the LAR and multiple parameters, we developed new nomograms and externally validated the tools.
We conducted an observational study using a prospective, multicenter registry of out-of-cardiac arrest resuscitation provided by the Korean Cardiac Arrest Research Consortium registry from October 2015 to June 2017.
A total of 524 patients were included in this study. An increased LAR was significantly associated with decreased favorable neurologic outcomes (odds ratio [OR] 0.787; 95% confidence interval [CI], 0.630-0.983; P = 0.035) and survival at discharge (OR 0.744; 95% CI, 0.638-0.867; P < 0.001). The areas under the curve (AUCs) for predicting neurologic outcome and survival to discharge using the LAR were 0.824 (P < 0.001) and 0.781 (P < 0.001), respectively. An LAR value of more than the optimal cutoff values of 2.82 and 3.62 could significantly improve prediction of decreased favorable neurologic outcome and survival to discharge, respectively. We constructed nomograms based on the multivariate logistic model. The model for predicting favorable neurologic outcomes and survival discharge had AUCs of 0.927 (P < 0.001) and 0.872 (P < 0.001), respectively.
The prognostic performance of the LAR was superior to a single measurement of lactate for predicting favorable neurologic outcomes and survival to discharge after OHCA. The newly developed nomograms can provide rapid prediction of probability of clinical outcomes.
我们旨在评估乳酸/白蛋白比值（LAR），以评估其作为院外心脏骤停（OHCA）后自主循环恢复患者良好神经功能结局和生存的预后标志物的意义。基于 LAR 和多个参数，我们开发了新的列线图并对这些工具进行了外部验证。
我们使用韩国心脏骤停研究联盟注册中心提供的前瞻性、多中心院外心脏骤停复苏登记处进行了一项观察性研究，该研究于 2015 年 10 月至 2017 年 6 月进行。
本研究共纳入 524 例患者。较高的 LAR 与较低的良好神经功能结局（优势比[OR]0.787；95%置信区间[CI]0.630-0.983；P=0.035）和出院时的生存显著相关（OR 0.744；95%CI，0.638-0.867；P<0.001）。使用 LAR 预测神经功能结局和出院时生存的曲线下面积（AUCs）分别为 0.824（P<0.001）和 0.781（P<0.001）。LAR 值大于 2.82 和 3.62 的最佳截断值可以显著改善对较低的良好神经功能结局和出院时生存的预测。我们基于多变量逻辑模型构建了列线图。预测良好神经功能结局和出院时生存的模型 AUC 分别为 0.927（P<0.001）和 0.872（P<0.001）。
与单个乳酸测量值相比，LAR 对预测 OHCA 后良好神经功能结局和出院时生存的预后性能更优。新开发的列线图可以快速预测临床结局的概率。
