Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama-Shi, Saitama, 330-8503, Japan.
Division of Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan.
BMC Cardiovasc Disord. 2024 Jun 14;24(1):303. doi: 10.1186/s12872-024-03975-z.
In patients who experience out-of-hospital cardiac arrest (OHCA), it is important to assess the association of sub-phenotypes identified by latent class analysis (LCA) using pre-hospital prognostic factors and factors measurable immediately after hospital arrival with neurological outcomes at 30 days, which would aid in making treatment decisions.
This study retrospectively analyzed data obtained from the Japanese OHCA registry between June 2014 and December 2019. The registry included a complete set of data on adult patients with OHCA, which was used in the LCA. The association between the sub-phenotypes and 30-day survival with favorable neurological outcomes was investigated. Furthermore, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by multivariate logistic regression analysis using in-hospital data as covariates.
A total of, 22,261 adult patients who experienced OHCA were classified into three sub-phenotypes. The factor with the highest discriminative power upon patient's arrival was Glasgow Coma Scale followed by partial pressure of oxygen. Thirty-day survival with favorable neurological outcome as the primary outcome was evident in 66.0% participants in Group 1, 5.2% in Group 2, and 0.5% in Group 3. The 30-day survival rates were 80.6%, 11.8%, and 1.3% in groups 1, 2, and 3, respectively. Logistic regression analysis revealed that the ORs (95% CI) for 30-day survival with favorable neurological outcomes were 137.1 (99.4-192.2) for Group 1 and 4.59 (3.46-6.23) for Group 2 in comparison to Group 3. For 30-day survival, the ORs (95%CI) were 161.7 (124.2-212.1) for Group 1 and 5.78 (4.78-7.04) for Group 2, compared to Group 3.
This study identified three sub-phenotypes based on the prognostic factors available immediately after hospital arrival that could predict neurological outcomes and be useful in determining the treatment strategy of patients experiencing OHCA upon their arrival at the hospital.
在经历院外心脏骤停（OHCA）的患者中，评估使用院前预后因素和入院后即刻可测量因素识别的亚表型与 30 天神经结局的关联非常重要，这将有助于治疗决策。
本研究回顾性分析了 2014 年 6 月至 2019 年 12 月期间日本 OHCA 注册中心获得的数据。该注册中心包含了 OHCA 成年患者的完整数据集，用于 LCA。研究了亚表型与 30 天生存且神经功能良好结局的关系。此外，通过使用入院数据作为协变量的多变量逻辑回归分析，估计调整后的比值比（OR）和 95%置信区间（CI）。
共将 22261 例经历 OHCA 的成年患者分为 3 个亚表型。患者到达时具有最高判别能力的因素是格拉斯哥昏迷量表，其次是氧分压。作为主要结局的 30 天生存且神经功能良好结局在第 1 组中占 66.0%，第 2 组中占 5.2%，第 3 组中占 0.5%。第 1、2 和 3 组的 30 天生存率分别为 80.6%、11.8%和 1.3%。逻辑回归分析显示，与第 3 组相比，第 1 组和第 2 组 30 天生存且神经功能良好结局的 OR（95%CI）分别为 137.1（99.4-192.2）和 4.59（3.46-6.23）。对于 30 天生存，第 1 组和第 2 组的 OR（95%CI）分别为 161.7（124.2-212.1）和 5.78（4.78-7.04），与第 3 组相比。
本研究根据入院后即刻可用的预后因素确定了 3 个亚表型，这些亚表型可以预测神经结局，并有助于确定患者到达医院时的治疗策略。
