Luck Trevor G, Locke Katherine, Sherman Benjamin C, Vibbert Matthew, Hefton Sara, Shah Syed Omar
Drexel University College of Medicine, Philadelphia, PA, USA.
Division of Neurocritical Care, Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA, 19107, USA.
Neurocrit Care. 2023 Feb;38(1):129-137. doi: 10.1007/s12028-022-01570-8. Epub 2022 Jul 28.
Hypoxic brain injury is the leading cause of death in comatose patients following resuscitation from cardiac arrest. Neurological outcome can be difficult to prognosticate following resuscitation, and goals of care discussions are often informed by multiple prognostic tools. One tool that has shown promise is the SLANT score, which encompasses five metrics including initial nonshockable rhythm, leukocyte count after targeted temperature management, total adrenaline dose during resuscitation, lack of bystander cardiopulmonary resuscitation, and time to return of spontaneous circulation. This cohort study aimed to provide an external validation of this score by using a database of comatose cardiac arrest survivors from our institution.
We retrospectively queried our database of cardiac arrest survivors, selecting for patients with coma, sustained return of spontaneous circulation, and use of targeted temperature management to have a comparable sample to the index study. We calculated SLANT scores for each patient and separated them into risk levels, both according to the original study and according to a Youden index analysis. The primary outcome was poor neurologic outcome (defined by a cerebral performance category score of 3 or greater at discharge), and the secondary outcome was in-hospital mortality. Univariable and multivariable analyses, as well as a receiver operator characteristic curve, were used to assess the SLANT score for independent predictability and diagnostic accuracy for poor outcomes.
We demonstrate significant association between a SLANT group with increased risk and poor neurologic outcome on univariable (p = 0.005) and multivariable analysis (odds ratio 1.162, 95% confidence interval 1.003-1.346, p = 0.046). A receiver operating characteristic analysis indicates that SLANT scoring is a fair prognostic test for poor neurologic outcome (area under the curve 0.708, 95% confidence interval 0.536-0.879, p = 0.024). Among this cohort, the most frequent SLANT elements were initial nonshockable rhythm (84.5%) and total adrenaline dose ≥ 5 mg (63.9%). There was no significant association between SLANT score and in-hospital mortality (p = 0.064).
The SLANT score may independently predict poor neurologic outcome but not in-hospital mortality. Including the SLANT score as part of a multimodal approach may improve our ability to accurately prognosticate comatose survivors of cardiac arrest.
缺氧性脑损伤是心脏骤停复苏后昏迷患者的主要死亡原因。复苏后神经功能结局难以预测，护理目标的讨论通常由多种预后工具提供信息。一种显示出前景的工具是SLANT评分，它包括五个指标，即初始不可电击心律、目标温度管理后的白细胞计数、复苏期间的总肾上腺素剂量、旁观者未进行心肺复苏以及自主循环恢复时间。这项队列研究旨在通过使用我们机构昏迷心脏骤停幸存者的数据库对该评分进行外部验证。
我们回顾性查询了心脏骤停幸存者数据库，选择昏迷、自主循环持续恢复且接受目标温度管理的患者，以获得与索引研究可比的样本。我们为每位患者计算SLANT评分，并根据原始研究和尤登指数分析将其分为风险水平。主要结局是神经功能结局不良（出院时脑功能类别评分为3或更高定义），次要结局是住院死亡率。使用单变量和多变量分析以及受试者工作特征曲线来评估SLANT评分对不良结局的独立预测能力和诊断准确性。
我们在单变量分析（p = 0.005）和多变量分析（比值比1.162，95%置信区间1.003 - 1.346，p = 0.046）中证明，风险增加的SLANT组与神经功能结局不良之间存在显著关联。受试者工作特征分析表明，SLANT评分对于神经功能结局不良是一个中等的预后测试（曲线下面积0.708，95%置信区间0.536 - 0.879，p = 0.024）。在该队列中，最常见的SLANT因素是初始不可电击心律（84.5%）和总肾上腺素剂量≥5mg（63.9%）。SLANT评分与住院死亡率之间无显著关联（p = 0.064）。
SLANT评分可能独立预测神经功能结局不良，但不能预测住院死亡率。将SLANT评分纳入多模式方法的一部分可能会提高我们准确预测心脏骤停昏迷幸存者结局的能力。
