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Shinada K, Matsuoka A, Koami H, Sakamoto Y. Bayesian network predicted variables for good neurological outcomes in patients with out-of-hospital cardiac arrest. PLoS One 2023; 18:e0291258. [PMID: 37768915 PMCID: PMC10538776 DOI: 10.1371/journal.pone.0291258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/24/2023] [Indexed: 09/30/2023] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is linked to a poor prognosis and remains a public health concern. Several studies have predicted good neurological outcomes of OHCA. In this study, we used the Bayesian network to identify variables closely associated with good neurological survival outcomes in patients with OHCA. This was a retrospective observational study using the Japan Association for Acute Medicine OHCA registry. Fifteen explanatory variables were used, and the outcome was one-month survival with Glasgow-Pittsburgh cerebral performance category (CPC) 1-2. The 2014-2018 dataset was used as training data. The variables selected were identified and a sensitivity analysis was performed. The 2019 dataset was used for the validation analysis. Four variables were identified, including the motor response component of the Glasgow Coma Scale (GCS M), initial rhythm, age, and absence of epinephrine. Estimated probabilities were increased in the following order: GCS M score: 2-6; epinephrine: non-administered; initial rhythm: spontaneous rhythm and shockable; and age: <58 and 59-70 years. The validation showed a sensitivity of 75.4% and a specificity of 95.4%. We identified GCS M score of 2-6, initial rhythm (spontaneous rhythm and shockable), younger age, and absence of epinephrine as variables associated with one-month survival with CPC 1-2. These variables may help clinicians in the decision-making process while treating patients with OHCA.
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Affiliation(s)
- Kota Shinada
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Ayaka Matsuoka
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Hiroyuki Koami
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Yuichiro Sakamoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
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Lee J, Lee H, Oh J, Lim TH, Kang H, Ko BS, Cho Y. Association between Initial Serum Cholesterol Levels and Outcomes of Patients Hospitalized after Out-of-Hospital Cardiac Arrest: A Retrospective Multicenter Registry Study. J Pers Med 2022; 12:jpm12020233. [PMID: 35207721 PMCID: PMC8875378 DOI: 10.3390/jpm12020233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 02/01/2023] Open
Abstract
Purpose: This study aimed to investigate the association between total serum cholesterol levels and outcomes upon discharge in patients after out-of-hospital cardiac arrest (OHCA). Methods: We performed a retrospective observational study using the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry. Patients after OHCA whose total serum cholesterol levels were measured within 24 h after arriving at the emergency department were included in the analysis. The association between total serum cholesterol level and neurological outcomes upon discharge and survival to discharge was estimated. Results: Of the 12,321 patients after OHCA enrolled in the registry from October 2015 to June 2020, 689 patients were included. The poor neurologic outcome upon discharge group had a statistically significant lower total serum cholesterol level compared to the good neurologic outcome group (127.5 ± 45.1 mg/dL vs. 155.1 ± 48.9 mg/dL, p < 0.001). As a result of multivariate logistic regression analysis, the odds ratio for the neurologic outcome of total serum cholesterol levels was 2.00 (95% confidence interval [CI] 1.01–3.96, p = 0.045). The odds ratio for in-hospital death was 1.72 (95% CI 1.15–2.57, p = 0.009). Conclusions: Low total serum cholesterol levels could be associated with poor neurologic outcomes upon discharge and in-hospital death of patients hospitalized after OHCA.
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Affiliation(s)
| | | | - Jaehoon Oh
- Correspondence: ; Tel.: +82-2-2290-9829; Fax: +82-2-2290-9280
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Yang JK, Kim YJ, Jeong J, Kim J, Park JH, Ro YS, Shin SD. Low serum cholesterol level as a risk factor for out-of-hospital cardiac arrest: a case-control study. Clin Exp Emerg Med 2022; 8:296-306. [PMID: 35000357 PMCID: PMC8743677 DOI: 10.15441/ceem.20.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/27/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We aimed to identify the association between low serum total cholesterol levels and the risk of out-of-hospital cardiac arrest (OHCA). METHODS This case-control study was performed using datasets from the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES) project and the Korea National Health and Nutrition Examination Survey (KNHANES). Cases were defined as emergency medical service-treated adult patients who experienced OHCA with a presumed cardiac etiology from the CAPTURES project dataset. Four controls from the KNHANES dataset were matched to each case based on age, sex, and county. Multivariable conditional logistic regression analysis was conducted to evaluate the effect of total cholesterol levels on OHCA. RESULTS A total of 607 matched case-control pairs were analyzed. We classified total cholesterol levels into six categories (<148, 148-166.9, 167-189.9, 190-215.9, 216-237.9, and ≥238 mg/dL) according to the distribution of total cholesterol levels in the KNHANES dataset. Subjects with a total cholesterol level of 167-189.9 mg/dL (25th-49th percentile of the KNHANES dataset) were used as the reference group. In both the adjusted models and sensitivity analysis, a total cholesterol level of <148 mg/dL was significantly associated with OHCA (adjusted odds ratio [95% confidence interval], 6.53 [4.47-9.56]). CONCLUSION We identified an association between very-low total cholesterol levels and an increased risk of OHCA in a large, community-based population. Future prospective studies are needed to better understand how a low lipid profile is associated with OHCA.
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Affiliation(s)
- Jae Kwang Yang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yu Jin Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Jungeun Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
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Lee H, Shin H, Oh J, Lim TH, Kang BS, Kang H, Choi HJ, Kim C, Park JH. Association between Body Mass Index and Outcomes in Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8389. [PMID: 34444142 PMCID: PMC8394455 DOI: 10.3390/ijerph18168389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022]
Abstract
Increased body mass index (BMI) is a risk factor for cardiovascular disease, stroke, and metabolic diseases. A high BMI may affect outcomes of post-cardiac arrest patients, but the association remains debatable. We aimed to determine the association between BMI and outcomes in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). A systematic literature search was conducted using MEDLINE, EMBASE, and the Cochrane Library. Studies that included patients who presented ROSC after OHCA, had a recorded BMI, and were assessed for neurological outcomes and in-hospital mortality were included. To assess the risk of bias of each included study, we employed the Risk of Bias Assessment Tool for Non-randomized Studies. We assessed 2427 patients from six studies. Neurological outcomes were significantly poorer in underweight patients (risk ratio (RR) = 1.21; 95% confidence interval (CI) = 1.07-1.37; p = 0.002; I2 = 51%) than in normal-weight patients. Additionally, in-hospital mortality rate was significantly higher in underweight patients (RR = 1.35; 95% CI = 1.14-1.60; p<0.001; I2 = 21%) and in obese patients (RR = 1.25; 95% CI = 1.12-1.39; p<0.001; I2 = 0%) than in normal-weight patients. Poor neurological outcome is associated with underweight, and low survival rate is associated with underweight and obesity in patients with ROSC after OHCA.
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Affiliation(s)
- Heekyung Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Hyungoo Shin
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Tae-Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Bo-Seung Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Hyuk-Joong Choi
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Changsun Kim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Jung-Hwan Park
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea;
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Lee SE, Kim HH, Chae MK, Park EJ, Choi S. Predictive Value of Estimated Lean Body Mass for Neurological Outcomes after Out-of-Hospital Cardiac Arrest. J Clin Med 2020; 10:jcm10010071. [PMID: 33379208 PMCID: PMC7794946 DOI: 10.3390/jcm10010071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Postcardiac arrest patients with a return of spontaneous circulation (ROSC) are critically ill, and high body mass index (BMI) is ascertained to be associated with good prognosis in patients with a critically ill condition. However, the exact mechanism has been unknown. To assess the effectiveness of skeletal muscles in reducing neuronal injury after the initial damage owing to cardiac arrest, we investigated the relationship between estimated lean body mass (LBM) and the prognosis of postcardiac arrest patients. Methods: This retrospective cohort study included adult patients with ROSC after out-of-hospital cardiac arrest from January 2015 to March 2020. The enrolled patients were allocated into good- and poor-outcome groups (cerebral performance category (CPC) scores 1–2 and 3–5, respectively). Estimated LBM was categorized into quartiles. Multivariate regression models were used to evaluate the association between LBM and a good CPC score. The area under the receiver operating characteristic curve (AUROC) was assessed. Results: In total, 155 patients were analyzed (CPC score 1–2 vs. 3–5, n = 70 vs. n = 85). Patients’ age, first monitored rhythm, no-flow time, presumed cause of arrest, BMI, and LBM were different (p < 0.05). Fourth-quartile LBM (≥48.98 kg) was associated with good neurological outcome of postcardiac arrest patients (odds ratio = 4.81, 95% confidence interval (CI), 1.10–25.55, p = 0.04). Initial high LBM was also a predictor of good neurological outcomes (AUROC of multivariate regression model including LBM: 0.918). Conclusions: Initial LBM above 48.98kg is a feasible prognostic factor for good neurological outcomes in postcardiac arrest patients.
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Affiliation(s)
- Sung Eun Lee
- Department of Emergency Medicine, School of Medicine, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea; (S.E.L.); (M.K.C.); (E.J.P.); (S.C.)
- Department of Neurology, School of Medicine, Ajou University, Suwon 16499, Korea
| | - Hyuk Hoon Kim
- Department of Emergency Medicine, School of Medicine, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea; (S.E.L.); (M.K.C.); (E.J.P.); (S.C.)
- Correspondence: ; Tel.: +82-31-219-7751; Fax: +82-31-219-7760
| | - Minjung Kathy Chae
- Department of Emergency Medicine, School of Medicine, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea; (S.E.L.); (M.K.C.); (E.J.P.); (S.C.)
| | - Eun Jung Park
- Department of Emergency Medicine, School of Medicine, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea; (S.E.L.); (M.K.C.); (E.J.P.); (S.C.)
| | - Sangchun Choi
- Department of Emergency Medicine, School of Medicine, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea; (S.E.L.); (M.K.C.); (E.J.P.); (S.C.)
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Ni J, Liu Y, Wu M, Wang J, Sha D, Xu B. Shock on Admission as a Potential Marker for ICU Mortality of Cardiac Arrest Patients. Int Heart J 2020; 61:795-798. [DOI: 10.1536/ihj.20-040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jie Ni
- Department of Emergency, Nanjing Drum Tower Hospital, Nanjing University Medical School
| | - Yihai Liu
- Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University
| | - Mingyue Wu
- Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University
| | - Jun Wang
- Department of Emergency, Nanjing Drum Tower Hospital, Nanjing University Medical School
| | - Dujuan Sha
- Department of General Medical, Nanjing Drum Tower Hospital, Nanjing University Medical School
| | - Biao Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University
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