Lee Sunghyuk, Park Jung Soo, You Yeonho, Min Jin Hong, Jeong Wonjoon, Ahn Hong Joon, In Yong Nam, Cho Yong Chul, Lee In Ho, Lee Jae Kwang, Kang Changshin
Department of Emergency Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Republic of Korea.
Department of Emergency Medicine, College of Medicine, Chungnam National University, 282 Mokdong-ro, Jung-gu, Daejeon 35015, Republic of Korea.
Diagnostics (Basel). 2023 Jun 26;13(13):2174. doi: 10.3390/diagnostics13132174.
We investigated prognostic strategies for predicting good outcomes in the early stage of post-cardiac-arrest care using multiple prognostic tests that are available until 24 h after the return of spontaneous circulation (ROSC). A retrospective analysis was conducted on 138 out-of-hospital cardiac-arrest patients who underwent prognostic tests, including the gray-white-matter ratio (GWR-BG), the Glasgow Coma Scale motor (GCS-M) score before sedative administration, and the neuron-specific enolase (NSE) level measured at 24 h after the ROSC. We investigated the prognostic performances of the tests as single predictors and in various combination strategies. Classification and regression-tree analysis were used to provide a reliable model for the risk stratification. Out of all the patients, 55 (44.0%) had good outcomes. The NSE level showed the highest prognostic performance as a single prognostic test and provided improved specificities (>70%) and sensitivities (>98%) when used in combination strategies. Low NSE levels (≤32.1 ng/mL) and high GCS-M (≥4) scores identified good outcomes without misclassification. The overall accuracy for good outcomes was 81.8%. In comatose patients with low NSE levels or high GCS-M scores, the premature withdrawal of life-sustaining therapy should be avoided, thereby complying with the formal prognostication-strategy algorithm after at least 72 h from the ROSC.
我们使用多种预后测试方法，对心脏骤停后护理早期预测良好预后的策略进行了研究，这些测试方法可在自主循环恢复（ROSC）后24小时内使用。对138例接受预后测试的院外心脏骤停患者进行了回顾性分析，这些测试包括灰白质比率（GWR-BG）、镇静前的格拉斯哥昏迷量表运动（GCS-M）评分以及ROSC后24小时测量的神经元特异性烯醇化酶（NSE）水平。我们研究了这些测试作为单一预测指标以及在各种联合策略中的预后性能。使用分类和回归树分析来提供一个可靠的风险分层模型。在所有患者中，55例（44.0%）预后良好。NSE水平作为单一预后测试显示出最高的预后性能，并且在联合策略中使用时具有更高的特异性（>70%）和敏感性（>98%）。低NSE水平（≤32.1 ng/mL）和高GCS-M（≥4）评分可准确识别良好预后。良好预后的总体准确率为81.8%。对于NSE水平低或GCS-M评分高的昏迷患者，应避免过早撤除维持生命的治疗，从而在ROSC后至少72小时后遵循正式的预后策略算法。
