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Merrelaar AE, Bögl MS, Buchtele N, Merrelaar M, Herkner H, Schoergenhofer C, Harenberg J, Douxfils J, Siriez R, Jilma B, Spiel AO, Schwameis M. Performance of a Qualitative Point-of-Care Strip Test to Detect DOAC Exposure at the Emergency Department: A Cohort-Type Cross-Sectional Diagnostic Accuracy Study. Thromb Haemost 2022; 122:1723-1731. [PMID: 35785816 PMCID: PMC9512583 DOI: 10.1055/s-0042-1750327] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
An accurate point-of-care test for detecting effective anticoagulation by direct oral anticoagulants (DOACs) in emergencies is an unmet need. We investigated the accuracy of a urinary qualitative strip test (DOAC Dipstick) to detect relevant DOAC exposure in patients who presented to an emergency department. In this prospective single-center cohort-type cross-sectional study, adults on DOAC treatment were enrolled. We assessed clinical sensitivity and specificity of DOAC Dipstick factor Xa and thrombin inhibitor pads to detect DOAC plasma levels ≥30 ng/mL using urine samples as the testing matrix. Liquid chromatography coupled with tandem-mass spectrometry was used as the reference standard method for plasma and urine measurement of DOAC concentrations. Of 293 patients enrolled, 265 patients were included in the analysis, of whom 92 were treated with rivaroxaban, 65 with apixaban, 77 with edoxaban, and 31 with dabigatran. The clinical sensitivity and specificity of the dipstick on urine samples to detect ≥30 ng/mL dabigatran plasma levels were 100% (95% confidence interval [CI]: 87–100%) and 98% (95% CI: 95–99%), respectively. The sensitivity and specificity of the dipstick to detect ≥30 ng/mL factor Xa inhibitor plasma levels were 97% (95% CI: 94–99%) and 69% (95% CI: 56–79%), respectively. The DOAC Dipstick sensitively identified effective thrombin and factor Xa inhibition in a real-world cohort of patients presenting at an emergency department. Therefore, the dipstick might provide a valuable test to detect relevant DOAC exposure in emergencies, although further studies will be needed to confirm these findings.
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Affiliation(s)
- Anne E Merrelaar
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Magdalena S Bögl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Nina Buchtele
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marieke Merrelaar
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Job Harenberg
- Ruprecht-Karls-University, Heidelberg, Germany.,Doasense GmbH, Heidelberg, Germany
| | - Jonathan Douxfils
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center, University of Namur, Namur, Belgium.,Qualiblood s.a., Department of Research and Development, Namur, Belgium
| | - Romain Siriez
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center, University of Namur, Namur, Belgium
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Alexander O Spiel
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.,Department of Emergency Medicine, Klinik Ottakring, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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Cacioppo F, Schwameis M, Schuetz N, Oppenauer J, Schnaubelt S, Simon A, Lutnik M, Gupta S, Roth D, Herkner H, Spiel AO, Laggner AN, Domanovits H, Niederdoeckl J. Cardioversion of Post-Ablation Atrial Tachyarrhythmia with Ibutilide and Amiodarone: A Registry-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116606. [PMID: 35682190 PMCID: PMC9180807 DOI: 10.3390/ijerph19116606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/10/2022]
Abstract
Patients with recurrence of atrial tachyarrhythmia after catheter ablation for atrial fibrillation or atrial flutter constitute a rapidly growing cohort, but study-driven treatment recommendations are lacking. The present study aimed to compare the cardioversion success of ibutilide and amiodarone in patients with post-ablation atrial tachyarrhythmia. We included all episodes of post-ablation atrial tachyarrhythmia in patients treated with either intravenous ibutilide or amiodarone at an academic emergency department from 2010 to 2018. The primary endpoint was the conversion to sinus rhythm. The conversion rates were stratified by arrhythmia type, and multivariable cluster-adjusted logistic regression was used to estimate the effect of ibutilide and amiodarone on cardioversion success, given as the odds ratio (OR) with 95% confidence intervals (95% CI). In total, 109 episodes of 72 patients were analyzed. The conversion rates were 37/49 (76%) for ibutilide and 16/60 (27%) for amiodarone. Compared to amiodarone, ibutilide was associated with higher odds of conversion (multivariable cluster-adjusted OR 5.6, 95% CI 1.3–24.3). The cardioversion success of ibutilide was the highest in atrial flutter (crude OR 19.5, 95% CI 3.4–112.5) and focal atrial tachycardia (crude OR 8.3, 95% CI 1.5–47.2), but it was less pronounced in atrial fibrillation (crude OR 4.5, 95% CI 1.2–17.2). Randomized trials are warranted to confirm our findings.
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Affiliation(s)
- Filippo Cacioppo
- Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.C.); (M.S.); (N.S.); (J.O.); (S.S.); (S.G.); (D.R.); (H.H.); (A.N.L.); (H.D.); (J.N.)
| | - Michael Schwameis
- Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.C.); (M.S.); (N.S.); (J.O.); (S.S.); (S.G.); (D.R.); (H.H.); (A.N.L.); (H.D.); (J.N.)
| | - Nikola Schuetz
- Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.C.); (M.S.); (N.S.); (J.O.); (S.S.); (S.G.); (D.R.); (H.H.); (A.N.L.); (H.D.); (J.N.)
| | - Julia Oppenauer
- Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.C.); (M.S.); (N.S.); (J.O.); (S.S.); (S.G.); (D.R.); (H.H.); (A.N.L.); (H.D.); (J.N.)
| | - Sebastian Schnaubelt
- Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.C.); (M.S.); (N.S.); (J.O.); (S.S.); (S.G.); (D.R.); (H.H.); (A.N.L.); (H.D.); (J.N.)
| | - Alexander Simon
- Clinic Ottakring, Department of Emergency Medicine, Montleartstraße 37, 1160 Vienna, Austria;
| | - Martin Lutnik
- Medical University of Vienna, Department of Clinical Pharmacology, Waehringer Guertel 18-20, 1090 Vienna, Austria;
| | - Sophie Gupta
- Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.C.); (M.S.); (N.S.); (J.O.); (S.S.); (S.G.); (D.R.); (H.H.); (A.N.L.); (H.D.); (J.N.)
| | - Dominik Roth
- Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.C.); (M.S.); (N.S.); (J.O.); (S.S.); (S.G.); (D.R.); (H.H.); (A.N.L.); (H.D.); (J.N.)
| | - Harald Herkner
- Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.C.); (M.S.); (N.S.); (J.O.); (S.S.); (S.G.); (D.R.); (H.H.); (A.N.L.); (H.D.); (J.N.)
| | - Alexander Oskar Spiel
- Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.C.); (M.S.); (N.S.); (J.O.); (S.S.); (S.G.); (D.R.); (H.H.); (A.N.L.); (H.D.); (J.N.)
- Clinic Ottakring, Department of Emergency Medicine, Montleartstraße 37, 1160 Vienna, Austria;
- Correspondence:
| | - Anton Norbert Laggner
- Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.C.); (M.S.); (N.S.); (J.O.); (S.S.); (S.G.); (D.R.); (H.H.); (A.N.L.); (H.D.); (J.N.)
| | - Hans Domanovits
- Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.C.); (M.S.); (N.S.); (J.O.); (S.S.); (S.G.); (D.R.); (H.H.); (A.N.L.); (H.D.); (J.N.)
| | - Jan Niederdoeckl
- Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.C.); (M.S.); (N.S.); (J.O.); (S.S.); (S.G.); (D.R.); (H.H.); (A.N.L.); (H.D.); (J.N.)
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Niederdöckl J, Simon A, Cacioppo F, Buchtele N, Merrelaar A, Schütz N, Schnaubelt S, Spiel AO, Roth D, Schörgenhofer C, Herkner H, Domanovits H, Schwameis M. Predicting spontaneous conversion to sinus rhythm in symptomatic atrial fibrillation: The ReSinus score. Eur J Intern Med 2021; 83:45-53. [PMID: 32951957 DOI: 10.1016/j.ejim.2020.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/14/2020] [Accepted: 07/31/2020] [Indexed: 12/14/2022]
Abstract
The optimal management of patients presenting to the Emergency Department with hemodynamically stable symptomatic atrial fibrillation remains unclear. We aimed to develop and validate an easy-to-use score to predict the individual probability of spontaneous conversion to sinus rhythm in these patients METHODS: This retrospective cohort study analyzed 2426 cases of first-detected or recurrent hemodynamically stable non-permanent symptomatic atrial fibrillation documented between January 2011 and January 2019 in an Austrian academic Emergency Department atrial fibrillation registry. Multivariable analysis was used to develop and validate a prediction score for spontaneous conversion to sinus rhythm during Emergency Department visit. Clinical usefulness of the score was assessed using decision curve analysis RESULTS: 1420 cases were included in the derivation cohort (68years, 57-76; 43% female), 1006 cases were included in the validation cohort (69years, 58-76; 47% female). Six variables independently predicted spontaneous conversion. These included: duration of atrial fibrillation symptoms (<24hours), lack of prior cardioversion history, heart rate at admission (>125bpm), potassium replacement at K+ level ≤3.9mmol/l, NT-proBNP (<1300pg/ml) and lactate dehydrogenase level (<200U/l). A risk score weight was assigned to each variable allowing classification into low (0-2), medium (3-5) and moderate (6-8) probability of spontaneous conversion. The final score showed good calibration (p=0.44 and 0.40) and discrimination in both cohorts (c-indices: 0.74 and 0.67) and clinical net benefit CONCLUSION: The ReSinus score, which predicts spontaneous conversion to sinus rhythm, was developed and validated in a large cohort of patients with hemodynamically stable non-permanent symptomatic atrial fibrillation and showed good calibration, discrimination and usefulness REGISTRATION: NCT03272620.
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Affiliation(s)
- Jan Niederdöckl
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alexander Simon
- Zentrale Notaufnahme, Wilhelminenspital, Montleartstr.37, 1160 Vienna, Austria
| | - Filippo Cacioppo
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Nina Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Anne Merrelaar
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Nikola Schütz
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alexander O Spiel
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; Zentrale Notaufnahme, Wilhelminenspital, Montleartstr.37, 1160 Vienna, Austria
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Christian Schörgenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Disseminated Intravascular Coagulation Is an Independent Predictor of Adverse Outcomes in Children in the Emergency Department with Suspected Sepsis. J Pediatr 2020; 225:198-206.e2. [PMID: 32553867 PMCID: PMC7529972 DOI: 10.1016/j.jpeds.2020.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the impact of early disseminated intravascular coagulation (DIC) on illness severity in children using a database of emergency department ED encounters for children with suspected sepsis, in view of similar associations in adults. STUDY DESIGN Laboratory and clinical data were extracted from a registry of emergency department encounters of children with suspected sepsis between April 1, 2012, and June 26, 2017. International Society of Thrombosis and Hemostasis DIC scores were calculated from laboratory values obtained within 24 hours of emergency department admission. Univariate logistic regression, multivariable logistic regression, and Cox regression were used to assess the influence of DIC scores on vasopressor use (primary outcome), mortality, ventilator requirement, pediatric intensive care unit admission, and hospital duration (secondary outcomes). The optimal DIC score cutoff for outcome prediction was determined. RESULTS Of 1653 eligible patients, 284 had DIC scores within 24 hours, including 92 who required vasopressors and 23 who died within 1 year. An initial DIC score of ≥3 was the most sensitive and specific DIC score for predicting adverse outcomes. Those with a DIC score of ≥3 vs <3 had increased odds of vasopressor use in both univariate (OR, 4.48; 95% CI, 2.63-7.62; P < .001) and multivariable (OR, 3.78; 95% CI, 1.82-7.85; P < .001) analyses. Additionally, those with a DIC score of ≥3 vs <3 had increased 1-year mortality with a hazard ratio of 3.55 (95% CI, 1.46-8.64; P = .005). CONCLUSIONS A DIC score of ≥3 was an independent predictor for both vasopressor use and mortality in this pediatric cohort, distinct from the adult overt DIC score cutoff of ≥5.
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Grafeneder J, Krychtiuk KA, Buchtele N, Schoergenhofer C, Gelbenegger G, Lenz M, Wojta J, Heinz G, Huber K, Hengstenberg C, Jilma B, Speidl WS. The ISTH DIC score predicts outcome in non-septic patients admitted to a cardiovascular intensive care unit. Eur J Intern Med 2020; 79:37-42. [PMID: 32622514 DOI: 10.1016/j.ejim.2020.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The International Society of Thrombosis and Haemostasis (ISTH) disseminated intravascular coagulation (DIC) score is widely used to predict mortality in critically ill - typically septic - patients. The objective of this study was to investigate whether the ISTH DIC-2001 and DIC-2018 score can be used to predict the 30-day mortality in non-septic patients in an intensive care unit (ICU). METHODS In this single-center, prospective observational study we included all patients ≥18 years of age who were admitted to a medical ICU with a focus on cardiovascular diseases between August 2012 and 2013. The DIC-2001 and DIC-2018 scores were calculated on admission (DIC-2001-0h and DIC-2018-0h) and 72 hours thereafter (DIC-2001-72h and DIC-2018-72h) and were classified as overt when ≥ 5 for DIC-2001 and ≥ 4 for DIC-2018. RESULTS A total of 233 patients were included in this study. Excluding septic patients and patients after routine surgery/procedures, we calculated the DIC score for 167 patients (32.4% female; median age 64.9 years). Overt DIC-2001-0h, DIC-2018-0h and overt DIC-2001-72h scores were associated with a significantly higher 30-day mortality rate (52.9% vs. 25.0%, 46.2% vs 21.2%, and 57.1% vs. 23.7%; p < 0.04). The DIC-2001 scores and the DIC-2018-0h score significantly predicted the 30-day mortality. CONCLUSION This study suggests that the DIC score may be applied to non-septic ICU populations, and indicates that it is a useful tool for mortality prediction, regardless of the underlying disease.
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Affiliation(s)
- Jürgen Grafeneder
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Konstantin A Krychtiuk
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Nina Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Department of Internal Medicine I - Intensive Care Unit 13i2, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Christian Schoergenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Georg Gelbenegger
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Max Lenz
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Johann Wojta
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Gottfried Heinz
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Kurt Huber
- 3rd Medical Department, Wilhelminenhospital, Montleartstraße 37, 1160 Vienna.
| | - Christian Hengstenberg
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Walter S Speidl
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Zhai Q, Feng L, Zhang H, Wu M, Wang D, Ge H, Li S, Du L, Zheng K, Li H, Liu S, Zhao J, Huai W, Ma Q. Serial disseminated intravascular coagulation score with neuron specific enolase predicts the mortality of cardiac arrest-a pilot study. J Thorac Dis 2020; 12:3573-3581. [PMID: 32802436 PMCID: PMC7399410 DOI: 10.21037/jtd-20-580] [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] [Indexed: 11/06/2022]
Abstract
Background Prognosis in cardiac arrest (CA) patients has been challenging. We sought to investigate prognostic value combining serial disseminated intravascular coagulation (DIC) score and neuron-specific enolase (NSE) in out-of-hospital cardiac arrest (OHCA) patients. Methods Sixty-one consecutive patients successfully resuscitated after CA were included in the analysis. DIC score and NSE levels were serially analyzed after return of spontaneous circulation (ROSC). The outcome measure was death before hospital discharge. Prognostication performance was assessed as the area under the receiver-operating characteristics curve (AUC). Hosmer-Lemeshow test was used for internal validation of predictive models. Calibration curves were drawn to visualize the results of tests. Results The NSE levels continued to increase in the first 72 h in non-survivors. In survivors, the NSE levels decreased after 48 h. Both DIC score at 48 h and NSE level at 48 h were good predictors of outcome. The AUC for predictive mortality in OHCA patients was 0.869 (95% CI, 0.781-0.956) for DIC score at 48 h combining NSE at 24 h, 0.878 (95% CI, 0.791-0.965) for DIC score at 48 h combining NSE at 48 h and 0.882 (95% CI, 0.792-0.972) for DIC score at 48 h combining NSE at 72 h, respectively. Significance of Hosmer-Lemeshow test was 0.488, 0.324, 0.011 for each combination. Conclusions Serial DIC score combined with measurement of NSE levels is a useful and accessible tool for prognostication following OHCA.
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Affiliation(s)
- Qiangrong Zhai
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Lu Feng
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Hua Zhang
- The Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, China
| | - Meng Wu
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Daidai Wang
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Hongxia Ge
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Shu Li
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Langfang Du
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Kang Zheng
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Hui Li
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Shaoyu Liu
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Jingjing Zhao
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Wei Huai
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Qingbian Ma
- Department of Emergency, Peking University Third Hospital, Beijing, China
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MUW researcher of the month. Wien Klin Wochenschr 2019; 131:630-631. [PMID: 31832816 DOI: 10.1007/s00508-019-01589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Buchtele N, Schober A, Schoergenhofer C, Spiel AO, Mauracher L, Weiser C, Sterz F, Jilma B, Schwameis M. Added value of the DIC score and of D-dimer to predict outcome after successfully resuscitated out-of-hospital cardiac arrest. Eur J Intern Med 2018; 57:44-48. [PMID: 29958747 DOI: 10.1016/j.ejim.2018.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/28/2018] [Accepted: 06/19/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recent Korean data suggest a high prevalence of overt disseminated intravascular coagulation (DIC) and a good predictive performance of the ISTH DIC score in successfully resuscitated out-of-hospital cardiac arrest. OBJECTIVES We hypothesised that in a European cohort of resuscitated out-of-hospital cardiac arrest patients the prevalence of DIC is substantially lower. Furthermore, the determination of D-dimer levels at admission, but not the DIC score, could improve mortality prediction above traditional predictors. PATIENTS/METHODS Data were extracted from a prospective cardiac arrest registry including patients admitted between 2006 and 2015, who achieved return of spontaneous circulation and had parameters for DIC score calculation available. The primary outcome was the prevalence of overt DIC at admission. Secondary outcomes included the association of overt DIC with 30-day mortality and the contribution of the DIC score and D-dimer levels to 30-day mortality prediction using logistic regression. Three stepwise models were evaluated by receiver-operating-characteristic analysis. RESULTS Out of 1179 patients 388 were included in the study. Overt DIC was present in 8% of patients and associated with substantial 30-day mortality (83% vs. 39%). The AUC for model 1, including traditional mortality predictors, was 0.83. The inclusion of D-dimer levels significantly improved prognostication above traditional predictors (model 3, AUC 0.89), whereas the inclusion of the DIC Score had no effect on mortality prediction (model 2, AUC 0.83). CONCLUSION Overt DIC was rare in a European cohort of out-of-hospital cardiac arrest patients. D-dimer levels improved 30-day mortality prediction and provided added value to assess early mortality risk after successful resuscitation.
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Affiliation(s)
- N Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - A Schober
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - C Schoergenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - A O Spiel
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - L Mauracher
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - C Weiser
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - F Sterz
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - B Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - M Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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