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血氨水平、院前时间和自主循环恢复能否预测院外心脏骤停患者的神经学结局？一项全国性回顾性队列研究。

Can Blood Ammonia Level, Prehospital Time, and Return of Spontaneous Circulation Predict Neurological Outcomes of Out-of-Hospital Cardiac Arrest Patients? A Nationwide, Retrospective Cohort Study.

作者信息

Nojima Tsuyoshi, Naito Hiromichi, Obara Takafumi, Ageta Kohei, Yakushiji Hiromasa, Yumoto Tetsuya, Fujisaki Noritomo, Nakao Atsunori

机构信息

Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.

Department of Primary Care and Medical Education, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.

出版信息

J Clin Med. 2022 May 4;11(9):2566. doi: 10.3390/jcm11092566.

DOI:10.3390/jcm11092566
PMID:35566692
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9105173/
Abstract

BACKGROUND

This study aimed to test if blood ammonia levels at hospital arrival, considering prehospital time and the patient's condition (whether return of spontaneous circulation [ROSC] was achieved at hospital arrival), can predict neurological outcomes after out-of-hospital cardiac arrest (OHCA).

METHODS

This was a retrospective cohort study on data from a nationwide OHCA registry in Japan. Patients over 17 years old and whose blood ammonia levels had been recorded were included. The primary outcome was favorable neurological outcome at 30 days after OHCA. Blood ammonia levels, prehospital time, and the combination of the two were evaluated using the receiver operating characteristic curve to predict favorable outcomes. Then, cut-off blood ammonia values were determined based on whether ROSC was achieved at hospital arrival.

RESULTS

Blood ammonia levels alone were sufficient to predict favorable outcomes. The overall cut-off ammonia value for favorable outcomes was 138 μg/dL; values were different for patients with ROSC (96.5 μg/dL) and those without ROSC (156 μg/dL) at hospital arrival.

CONCLUSIONS

Our results using patient data from a large OHCA registry showed that blood ammonia levels at hospital arrival can predict neurological outcomes, with different cut-off values for patients with or without ROSC at hospital arrival.

摘要

背景

本研究旨在检验入院时的血氨水平，结合院前时间及患者病情（入院时是否实现自主循环恢复[ROSC]），能否预测院外心脏骤停（OHCA）后的神经功能结局。

方法

这是一项基于日本全国OHCA登记处数据的回顾性队列研究。纳入17岁以上且记录了血氨水平的患者。主要结局是OHCA后30天时良好的神经功能结局。使用受试者工作特征曲线评估血氨水平、院前时间以及两者的组合，以预测良好结局。然后，根据入院时是否实现ROSC确定血氨临界值。

结果

仅血氨水平就足以预测良好结局。良好结局的总体血氨临界值为138μg/dL；入院时实现ROSC的患者（96.5μg/dL）和未实现ROSC的患者（156μg/dL）的血氨值有所不同。

结论

我们使用大型OHCA登记处患者数据的研究结果表明，入院时的血氨水平可以预测神经功能结局，入院时实现或未实现ROSC的患者有不同的临界值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96e9/9105173/7d6023a6dc07/jcm-11-02566-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96e9/9105173/4726caeae50a/jcm-11-02566-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96e9/9105173/412762651b46/jcm-11-02566-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96e9/9105173/32fc3b056874/jcm-11-02566-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96e9/9105173/7d6023a6dc07/jcm-11-02566-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96e9/9105173/4726caeae50a/jcm-11-02566-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96e9/9105173/412762651b46/jcm-11-02566-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96e9/9105173/32fc3b056874/jcm-11-02566-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96e9/9105173/7d6023a6dc07/jcm-11-02566-g004.jpg

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