Nakada Koki, Miyamoto Yuki, Kawama Toshinari, Hatakeyama Toshihiro, Kitamura Tetsuhisa, Ohta Bon, Matsuyama Tasuku
Department of Emergency Medicine Kyoto Prefectural University of Medicine Kyoto Japan.
Department of Emergency and Critical Care Medicine Dokkyo Medical University Saitama Medical Center Saitama Japan.
Acute Med Surg. 2025 Aug 13;12(1):e70082. doi: 10.1002/ams2.70082. eCollection 2025 Jan-Dec.
Predicting outcomes for out-of-hospital cardiac arrest (OHCA) patients remains challenging. We aimed to evaluate the association between the lactate/albumin ratio (LAR) upon hospital arrival and neurological outcomes in OHCA patients.
This multicenter, retrospective, nationwide observational study was based on data from the JAAM-OHCA registry, including 28,098 adults with non-traumatic OHCA from 140 emergency medical centers across Japan (June 2014 to December 2021). Receiver-operating characteristic curves assessed the predictive ability of LAR, lactate, and albumin levels. A reference model based on age, sex, witnessed arrest, initial cardiac rhythm, and time from call to hospital arrival was compared with models including LAR, lactate, or albumin levels. The primary outcome was a favorable neurological outcome at 30 days, with a secondary outcome at 90 days. Subgroup analyses were conducted among admitted patients and those who received active post-resuscitation treatments.
Among the 28,098 patients, 1421 (5.1%) achieved favorable neurological outcomes at 30 days. We demonstrated that LAR had a significantly higher area under the curve than either lactate or albumin for predicting both 30- and 90-day outcomes (all < 0.001), and better predictive value than either marker when added to the reference model. However, in the subgroup analysis of admitted patients, the statistical difference between LAR and albumin was no longer apparent.
The lower LAR upon hospital arrival was independently associated with a favorable neurological outcome in OHCA patients. However, its utility may vary depending on patient background, and further studies are needed to establish its clinical relevance.
预测院外心脏骤停（OHCA）患者的预后仍然具有挑战性。我们旨在评估OHCA患者入院时乳酸/白蛋白比值（LAR）与神经学预后之间的关联。
这项多中心、回顾性、全国性观察性研究基于JAAM-OHCA登记处的数据，包括来自日本140个急救医疗中心的28098例非创伤性OHCA成年患者（2014年6月至2021年12月）。受试者工作特征曲线评估了LAR、乳酸和白蛋白水平的预测能力。将基于年龄、性别、目击骤停、初始心律以及呼叫至入院时间的参考模型与包含LAR、乳酸或白蛋白水平的模型进行比较。主要结局是30天时良好的神经学预后，次要结局是90天时的情况。对入院患者和接受积极复苏后治疗的患者进行亚组分析。
在28098例患者中，1421例（5.1%）在30天时获得了良好的神经学预后。我们证明，LAR在预测30天和90天结局方面的曲线下面积显著高于乳酸或白蛋白（均P<0.001），并且添加到参考模型时比任何一个标志物都具有更好的预测价值。然而，在入院患者的亚组分析中，LAR与白蛋白之间的统计学差异不再明显。
OHCA患者入院时较低的LAR与良好的神经学预后独立相关。然而，其效用可能因患者背景而异，需要进一步研究以确定其临床相关性。
