Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea.
Department of Emergency Medicine, Kang Dong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Sci Rep. 2020 Oct 16;10(1):17549. doi: 10.1038/s41598-020-74842-y.
This study aimed to investigate whether the initial red cell distribution width (RDW) at the emergency department (ED) is associated with poor neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors. We performed a prospective observational analysis of patients admitted to the ED between October 2015 and June 2018 from the Korean Cardiac Arrest Research Consortium registry. We included OHCA patients who visited the ED and achieved return of spontaneous circulation. Initial RDW values were measured at the time of the ED visit. The primary outcome was a poor neurological (Cerebral Performance Category, or CPC) score of 3-5. A total of 1008 patients were ultimately included in this study, of whom 712 (70.6%) had poor CPC scores with unfavorable outcomes. Higher RDW quartiles (RDW 13.6-14.9%, RDW ≥ 15.0%), older age, female sex, nonshockable initial rhythm at the scene, unwitnessed cardiac arrest, bystander cardiopulmonary resuscitation (CPR), medical history, low white blood cell counts and high glucose levels were associated with poor neurological outcomes in univariate analysis. In multivariate analysis, the highest RDW quartile was independently associated with poor neurological outcomes (odds ratio 2.04; 95% confidence interval 1.12-3.69; p = 0.019) at hospital discharge after adjusting for other confounding factors. Other independent factors including age, initial rhythm, bystander CPR and high glucose were also associated with poor neurological outcomes. These results show that an initial RDW in the highest quartile as of the ED visit is associated with poor neurological outcomes at hospital discharge among OHCA survivors.
本研究旨在探讨急诊科（ED）初始红细胞分布宽度（RDW）是否与院外心脏骤停（OHCA）幸存者的不良神经结局相关。我们对 2015 年 10 月至 2018 年 6 月期间韩国心脏骤停研究联盟注册中心收治的 ED 患者进行了前瞻性观察分析。我们纳入了在 ED 就诊并恢复自主循环的 OHCA 患者。ED 就诊时测量初始 RDW 值。主要结局是不良神经（Cerebral Performance Category，CPC）评分 3-5 分。本研究共纳入 1008 例患者，其中 712 例（70.6%）预后不良，CPC 评分较差。较高的 RDW 四分位数（RDW 13.6-14.9%，RDW≥15.0%）、年龄较大、女性、现场非可除颤性初始节律、未经见证的心脏骤停、旁观者心肺复苏（CPR）、既往病史、低白细胞计数和高血糖水平与单因素分析中的不良神经结局相关。多因素分析显示，在校正其他混杂因素后，最高 RDW 四分位数与出院时不良神经结局独立相关（优势比 2.04；95%置信区间 1.12-3.69；p=0.019）。其他独立因素包括年龄、初始节律、旁观者 CPR 和高血糖也与不良神经结局相关。这些结果表明，ED 就诊时最高四分位 RDW 与 OHCA 幸存者出院时的不良神经结局相关。
