Department of Emergency Medicine, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA.
Division of Critical Care, Department of Anesthesia Critical Care, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA.
J Intensive Care Med. 2020 Dec;35(12):1483-1489. doi: 10.1177/0885066619873315. Epub 2019 Aug 29.
Outcome prediction after out-of-hospital cardiac arrest (OHCA) is difficult. We hypothesized that lactate and need for vasopressors would predict outcome, and that addition of a mitochondrial biomarker would enhance performance of the tool.
Prospective observational study of OHCA patients presenting to an academic medical center September 2008 to April 2016. We conducted univariate and multivariate logistic regressions.
Patients were divided based on 2 variables: vasopressor status and initial lactate (<5 mmol/L, 5-10, ≥10). Three hundred fifty-two patients were evaluated; 249 had a lactate within 3 hours and were included. Patients on vasopressors had higher mortality (74% vs 40%; < .001). A stepwise increase in mortality is associated with increasing lactate (45% lactate <5, 66% 5-10, and 83% ≥10; < 001). Multivariable models with lactate group and vasopressors as predictors demonstrated excellent discrimination (area under the receiver operating curve [AUC]: 0.73 [95% confidence interval, CI: 0.66-0.79]; adjusted for additional covariates: AUC: 0.81 [95% CI: 0.75-0.86]). Thirty-six patients had cytochrome levels available; among these 36, when comparing models with and without cytochrome , there was no difference (AUC: 0.88 [95% CI: 0.76-1.00] vs AUC: 0.85 [95% CI: 0.73-0.98], respectively; = .30).
In this prospective validation, the combination of lactate and vasopressors in the immediate postarrest period is predictive of mortality. Cytochrome offered minimal additional predictive power.
院外心脏骤停（OHCA）后的预后预测较为困难。我们假设乳酸和升压药的需求可预测预后，并且添加线粒体生物标志物将提高该工具的性能。
这是一项 2008 年 9 月至 2016 年 4 月在学术医疗中心进行的 OHCA 患者前瞻性观察性研究。我们进行了单变量和多变量逻辑回归分析。
患者根据以下 2 个变量进行分组：升压药的使用情况和初始乳酸水平（<5mmol/L、5-10mmol/L、≥10mmol/L）。共评估了 352 例患者，其中 249 例在 3 小时内进行了乳酸检测并纳入分析。使用升压药的患者死亡率更高（74%比 40%；<.001）。乳酸水平逐渐升高与死亡率的逐渐升高相关（<5mmol/L 组为 45%，5-10mmol/L 组为 66%，≥10mmol/L 组为 83%；<.001）。以乳酸分组和升压药为预测因子的多变量模型显示出良好的区分度（接受者操作特征曲线下面积[AUROC]：0.73[95%置信区间，CI：0.66-0.79]；调整其他协变量后：AUROC：0.81[95% CI：0.75-0.86]）。36 例患者有细胞色素 c 水平的检测结果；在这 36 例患者中，当比较包含和不包含细胞色素 c 的模型时，没有差异（AUROC：0.88[95% CI：0.76-1.00]与 AUC：0.85[95% CI：0.73-0.98]；=.30）。
在这项前瞻性验证中，即刻心脏骤停后乳酸和升压药的联合使用可预测死亡率。细胞色素 c 提供的预测能力有限。
