Seppä Asser M J, Skrifvars Markus B, Vuopio Heidi, Raj Rahul, Reinikainen Matti, Pekkarinen Pirkka T
Division of Intensive Care, Department of Anaesthesiology and Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Resusc Plus. 2024 Nov 2;20:100816. doi: 10.1016/j.resplu.2024.100816. eCollection 2024 Dec.
Post-resuscitation care of cardiac arrest patients may be complicated by systemic inflammation elicited in response to whole-body ischaemia-reperfusion injury. We assessed the association between early WBC with one-year mortality in a large, unselected population of cardiac arrest patients.
We collected a retrospective multicentre cohort of ICU-treated CA patients from the Finnish national ICU registry. We used locally estimated scatterplot smoothing (LOESS) curve to assess the association between the most abnormal WBC of the first 24 h in the ICU with the likelihood of death within a year. Multivariable logistic regression analyses were performed to assess the independent association between WBC and one-year mortality. In nested cohort analysis, we tested the association of delay from collapse to return of spontaneous circulation (ROSC) with WBC in linear regression models.
The LOESS curve was U-shaped, with the lowest predicted mortality at 7.5 10/L WBC. Based on this cut-off value, patients were divided into high (≥ 7.5 10/L) and low (< 7.5 10/L) WBC groups. In 4229 patients with high WBC, higher WBC was independently associated with increased one-year mortality (adjusted odds ratio (OR) 1.03 per 10/L, 95 % confidence interval (CI) 1.02-1.04, p < 0.001). In 776 patients with low WBC, lower WBC was independently associated with increased one-year mortality (adjusted OR 0.88 per 10/L, 95 % CI 0.80-0.96, p < 0.001). In a nested cohort analysis, longer ROSC-delay was associated with higher WBC in patients with a shockable rhythm (β = 0.10, R = 0.04, p < 0.001).
In this large retrospective cohort, WBC was independently associated with one-year mortality after CA. Mortality was lowest in patients with WBC close to the upper limit of the normal reference range. Although WBC is not useful for outcome prognostication in individual patients, our results support the concept of excess inflammation being a harmful component of the post-cardiac arrest syndrome.
心脏骤停患者复苏后的护理可能因全身缺血-再灌注损伤引发的全身炎症而变得复杂。我们评估了在一个大型、未经过筛选的心脏骤停患者群体中，早期白细胞计数（WBC）与一年死亡率之间的关联。
我们从芬兰国家重症监护病房登记处收集了一组接受重症监护病房治疗的心脏骤停患者的回顾性多中心队列数据。我们使用局部加权散点平滑（LOESS）曲线来评估重症监护病房中最初24小时内最异常的白细胞计数与一年内死亡可能性之间的关联。进行多变量逻辑回归分析以评估白细胞计数与一年死亡率之间的独立关联。在嵌套队列分析中，我们在线性回归模型中测试了从心脏骤停到自主循环恢复（ROSC）的延迟与白细胞计数之间的关联。
LOESS曲线呈U形，白细胞计数为7.5×10⁹/L时预测死亡率最低。基于此临界值，患者被分为白细胞计数高（≥7.5×10⁹/L）和低（<7.5×10⁹/L）两组。在4229例白细胞计数高的患者中，较高的白细胞计数与一年死亡率增加独立相关（调整后的优势比（OR）为每10⁹/L 1.03，95%置信区间（CI）为1.02 - 1.04，p < 0.001）。在776例白细胞计数低的患者中，较低的白细胞计数与一年死亡率增加独立相关（调整后的OR为每10⁹/L 0.88，95%CI为0.80 - 0.96，p < 0.001）。在嵌套队列分析中，对于可电击心律的患者，ROSC延迟时间越长，白细胞计数越高（β = 0.10，R² = 0.04，p < 0.001）。
在这个大型回顾性队列中，白细胞计数与心脏骤停后一年死亡率独立相关。白细胞计数接近正常参考范围上限的患者死亡率最低。虽然白细胞计数对个体患者的预后判断无用，但我们的结果支持过度炎症是心脏骤停后综合征有害组成部分的概念。
