Toftgaard Pedersen Anne, Kjaergaard Jesper, Hassager Christian, Frydland Martin, Hartvig Thomsen Jakob, Klein Anika, Schmidt Henrik, Møller Jacob Eifer, Wiberg Sebastian
Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
Scand Cardiovasc J. 2022 Dec;56(1):85-90. doi: 10.1080/14017431.2022.2074093.
Prognostication after out-of-hospital cardiac arrest (OHCA) remains challenging. The inflammatory response after OHCA has been associated with increased mortality. This study investigates the associations and predictive value between inflammatory markers and outcome in resuscitated OHCA patients.
The study is based on post hoc analyses of a double-blind controlled trial, where resuscitated OHCA patients were randomized to receive either exenatide or placebo. Blood was analyzed for levels of inflammatory markers the day following admission. Primary endpoint was time to death for up to 180 days. Secondary endpoints included 180-day mortality and poor neurological outcome after 180 days, defined as a cerebral performance category (CPC) of 3 to 5.
Among 110 included patients we found significant associations between higher leucocyte quartile and increasing mortality in univariable analysis (OR 2.6 (95%CI 1.6-4.2), < .001), as well as in multivariable analysis (OR 2.1 (95%CI 1.1-4.0), = .02). A significant association was found between higher neutrophil quartile and increasing mortality in univariable analysis (OR 3.0 (95%CI 1.8-5.0), < .001) as well as multivariable analysis (OR 2.4 (95%CI 1.2-4.6), = .01). Leucocyte and neutrophil levels were predictive of poor outcome after 180 days with area under the receiver operating characteristics curves of 0.79 and 0.81, respectively. We found no associations between CRP and lymphocyte levels versus outcome.
Total leucocyte count and neutrophil levels measured the first day following OHCA were significantly associated with 180-day all-cause mortality and may potentially act as early predictors of outcome.
www.clinicaltrials.gov, unique identifier: NCT02442791.
院外心脏骤停（OHCA）后的预后评估仍然具有挑战性。OHCA后的炎症反应与死亡率增加有关。本研究调查了复苏的OHCA患者炎症标志物与预后之间的关联及预测价值。
该研究基于一项双盲对照试验的事后分析，复苏的OHCA患者被随机分配接受艾塞那肽或安慰剂。入院次日分析血液中的炎症标志物水平。主要终点是长达180天的死亡时间。次要终点包括180天死亡率和180天后不良神经功能结局，定义为脑功能分类（CPC）为3至5级。
在110例纳入患者中，我们发现在单变量分析中较高的白细胞四分位数与死亡率增加之间存在显著关联（OR 2.6（95%CI 1.6 - 4.2），P <.001），在多变量分析中也是如此（OR 2.1（95%CI 1.1 - 4.0），P = .02）。在单变量分析中较高的中性粒细胞四分位数与死亡率增加之间存在显著关联（OR 3.0（95%CI 1.8 - 5.0），P <.001）以及多变量分析（OR 2.4（95%CI 1.2 - 4.6），P = .01）。白细胞和中性粒细胞水平可预测180天后的不良结局，受试者工作特征曲线下面积分别为0.79和0.81。我们未发现CRP和淋巴细胞水平与预后之间存在关联。
OHCA后第一天测量的白细胞总数和中性粒细胞水平与180天全因死亡率显著相关，可能作为结局的早期预测指标。
