院外心脏骤停患者自主循环恢复后肌钙蛋白I清除率与预后的关系
The Association between Troponin-I Clearance after the Return of Spontaneous Circulation and Outcomes in Out-of-Hospital Cardiac Arrest Patients.
作者信息
Lee Dong Hun, Lee Byung Kook, Ryu Seok Jin
机构信息
Department of Emergency Medicine, Chonnam National University Hospital, 61469 Gwangju, Republic of Korea.
Department of Emergency Medicine, Chonnam National University Medical School, 61469 Gwangju, Republic of Korea.
出版信息
Rev Cardiovasc Med. 2024 Jan 15;25(1):24. doi: 10.31083/j.rcm2501024. eCollection 2024 Jan.
BACKGROUND
Elevated levels of troponin-I (TnI) are common in out-of-hospital cardiac arrest (OHCA) patients. However, studies evaluating the prognostic value of TnI clearance in OHCA patients are lacking. We aimed to examine how TnI clearance (TnI-C) differed according to the neurological outcome group and mortality group at 6 months.
METHODS
This retrospective observational study involved adults ( 18 years) who were treated for an OHCA between January 2019 and December 2022. The TnI-Cs were calculated for days 1 to 2 (TnI-C1st) and 2 to 3 (TnI-C2nd) after the return of spontaneous circulation (ROSC). The primary outcome was a poor neurological outcome at 6 months, defined by cerebral performance categories 3, 4, and 5. The secondary outcome was 6-month mortality.
RESULTS
A total of 227 patients were included. A poor neurological outcome and mortality at 6-months were reported in 150 (66.1%) and 118 (52.0%) patients, respectively. The TnI-C1st was significantly lower in patients with a poor outcome compared with good outcome patients (neurological outcome at 6 months, 54.4% vs. 42.3%; 6-month mortality, 52.1% vs. 42.7%, respectively). In the multivariable analyses, a TnI-C1st 50% was associated with a poor neurological outcome (odds ratio [OR] 2.078, 95% confidence interval [CI] 1.080-3.995, = 0.028) and mortality (OR 2.131, 95% CI 1.114-4.078, = 0.022) at 6 months.
CONCLUSIONS
After ROSC, TnI-C1st 50% was associated with a poor neurological outcome and mortality at 6 months in OHCA patients.
背景
肌钙蛋白I（TnI）水平升高在院外心脏骤停（OHCA）患者中很常见。然而，评估TnI清除率对OHCA患者预后价值的研究尚缺乏。我们旨在研究6个月时TnI清除率（TnI-C）在神经学预后组和死亡率组之间如何不同。
方法
这项回顾性观察性研究纳入了2019年1月至2022年12月期间接受OHCA治疗的成年人（≥18岁）。计算自主循环恢复（ROSC）后第1至2天（TnI-C1st）和第2至3天（TnI-C2nd）的TnI-C。主要结局是6个月时神经学预后不良，由脑功能分类3、4和5定义。次要结局是6个月死亡率。
结果
共纳入227例患者。分别有150例（66.1%）和118例（52.0%）患者报告了6个月时神经学预后不良和死亡。预后不良患者的TnI-C1st显著低于预后良好患者（6个月时神经学预后，分别为54.4%对42.3%；6个月死亡率，分别为52.1%对42.7%）。在多变量分析中，TnI-C1st<50%与6个月时神经学预后不良（比值比[OR]2.078，95%置信区间[CI]1.080-3.995，P = 0.028）和死亡率（OR 2.131，95%CI 1.114-4.078，P = 0.022）相关。
结论
ROSC后，TnI-C1st<50%与OHCA患者6个月时神经学预后不良和死亡率相关。
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