Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan; Department of Cardiovascular Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan.
Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan.
J Cardiol. 2020 Sep;76(3):295-302. doi: 10.1016/j.jjcc.2020.03.007. Epub 2020 Apr 16.
Patients experiencing out-of-hospital cardiac arrest (OHCA) and subsequent post-cardiac arrest syndrome are often compromised by multi-organ failure. The Sequential Organ Failure Assessment (SOFA) score has been used to predict clinical outcome of patients requiring intensive care for multi-organ failure. Thus, the assessment of SOFA score is recommended as a criterion for sepsis. Although post-cardiac arrest patients frequently develop sepsis-like status in ICU, there are limited reports evaluating the SOFA score in post-cardiac arrest patients. We investigated the predictive value of the SOFA score in survival and neurological outcomes in patients with post-cardiac arrest syndrome.
A total of 231 cardiovascular arrest patients achieving return of spontaneous circulation (ROSC) were finally extracted from the institutional consecutive database comprised of 1218 OHCA patients transferred to the institution between January 2015 and July 2018. The SOFA score was calculated on admission and after 48h. Predictors of survival and neurological outcome defined as having cerebral-performance-category (CPC) 1 or 2 at 30 days were determined.
SOFA score was lower in survived patients (5.0 vs 10.0, p<0.001) and those with favorable neurological outcome (5.0 vs 8.0, p<0.001) as compared with the counterparts. The SOFA score on admission was an independent predictor of survival (OR 0.68, 95% confidence interval [CI] 0.59-0.78; p<0.001) and favorable neurological performance (OR 0.79; 95% CI 0.69-0.90; p<0.001) at 30 days. Furthermore, a change in SOFA score (48-0h) was predictive of favorable 30-day neurological outcome (OR 0.71, 95% CI 0.60-0.85; p<0.001).
Evaluation of the SOFA score in the ICU is useful to predict survival and neurological outcome in post-cardiac arrest patients.
经历院外心脏骤停 (OHCA) 和随后的心搏骤停后综合征的患者经常因多器官衰竭而受到影响。序贯器官衰竭评估 (SOFA) 评分已被用于预测需要重症监护治疗多器官衰竭的患者的临床结局。因此，SOFA 评分的评估被推荐作为脓毒症的标准。尽管心脏骤停后患者在 ICU 中经常出现类似脓毒症的状态，但评估心脏骤停后患者的 SOFA 评分的报道有限。我们研究了 SOFA 评分在心脏骤停后综合征患者的生存和神经结局中的预测价值。
从 2015 年 1 月至 2018 年 7 月期间转至该机构的 1218 例 OHCA 患者的机构连续数据库中，最终提取了 231 例心血管骤停患者实现自主循环恢复 (ROSC)。入院时和 48 小时后计算 SOFA 评分。确定了生存和神经结局的预测因素，定义为 30 天时具有脑功能分类 (CPC) 1 或 2。
与对照组相比，存活患者的 SOFA 评分较低（5.0 与 10.0，p<0.001），神经功能结局良好的患者的 SOFA 评分也较低（5.0 与 8.0，p<0.001）。入院时的 SOFA 评分是生存的独立预测因素（OR 0.68，95%置信区间 [CI] 0.59-0.78；p<0.001）和 30 天的良好神经功能（OR 0.79；95% CI 0.69-0.90；p<0.001）。此外，SOFA 评分的变化（48-0 小时）可预测 30 天的神经功能结局良好（OR 0.71，95% CI 0.60-0.85；p<0.001）。
在 ICU 中评估 SOFA 评分有助于预测心脏骤停后患者的生存和神经结局。
