Kim Jihyun, Kim Yong Won, Kim Tae-Youn
Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea.
J Clin Med. 2023 Apr 20;12(8):3006. doi: 10.3390/jcm12083006.
Out-of-hospital cardiac arrest (OHCA) is complex, and risk stratification tools have the potential to include components other than clinical risk indicators, thus requiring extensive studies. Simple and accurate biomarkers for OHCA patients with poor prognoses are still needed. Serum lactate dehydrogenase (LDH) has been identified as a risk factor in patients with various diseases, such as cancer, liver disease, severe infections, and sepsis. The primary aim of this study was to assess the accuracy of LDH values at initial presentation in the emergency department (ED) in predicting the clinical outcome in OHCA.
This retrospective multicenter observational study was performed in the ED of two tertiary university hospitals and one general hospital between January 2015 and December 2021. All patients with OHCA who visited the ED were included. The primary outcome was the sustained return of spontaneous circulation (ROSC; >20 min) after advanced cardiac life support (ACLS). The secondary outcome was survival to discharge (including home care and nursing care discharge) among patients with ROSC. The neurological prognosis was considered a tertiary outcome in patients who survived to discharge.
In total, 759 patients were enrolled in the final analysis. The median LDH level in the ROSC group was 448 U/L (range: 112-4500), which was significantly lower than that in the no-ROSC group ( < 0.001). The median LDH level in the survival-to-discharge group was 376 U/L (range: 171-1620), which was significantly lower than that in the death group ( < 0.001). Using the adjusted model, the odds ratio of the LDH value (≤634 U/L) for primary outcomes was 2.418 (1.665-3.513) and the odds ratio of LDH value (≤553 U/L) for secondary outcomes was 4.961 (2.184-11.269).
In conclusion, the serum LDH levels of patients with OHCA measured in the ED can potentially serve as a predictive marker for clinical outcomes such as ROSC and survival to discharge, although it may be difficult to predict neurological outcomes.
院外心脏骤停（OHCA）情况复杂，风险分层工具可能包含临床风险指标以外的因素，因此需要进行广泛研究。仍需要针对预后不良的OHCA患者的简单且准确的生物标志物。血清乳酸脱氢酶（LDH）已被确定为患有各种疾病（如癌症、肝病、严重感染和脓毒症）患者的一个风险因素。本研究的主要目的是评估急诊科（ED）初次就诊时LDH值预测OHCA临床结局的准确性。
本回顾性多中心观察性研究于2015年1月至2021年12月在两家三级大学医院和一家综合医院的急诊科进行。纳入所有前往急诊科就诊的OHCA患者。主要结局是高级心脏生命支持（ACLS）后自主循环持续恢复（ROSC；>20分钟）。次要结局是ROSC患者中出院存活（包括居家护理和护理院出院）。对于出院存活的患者，神经学预后被视为三级结局。
最终分析共纳入759例患者。ROSC组的LDH水平中位数为448 U/L（范围：112 - 4500），显著低于无ROSC组（<0.001）。出院存活组的LDH水平中位数为376 U/L（范围：171 - 1620），显著低于死亡组（<0.001）。使用校正模型，主要结局的LDH值（≤634 U/L）的比值比为2.418（1.665 - 3.513），次要结局的LDH值（≤553 U/L）的比值比为4.961（2.184 - 11.269）。
总之，在急诊科测量的OHCA患者血清LDH水平有可能作为ROSC和出院存活等临床结局的预测标志物，尽管可能难以预测神经学结局。
