Data_Sheet_1_Initial Blood pH, Lactate and Base Deficit Add No Value to Peri-Arrest Factors in Prognostication of Neurological Outcome After Out-of-Hospital Cardiac Arrest.pdf

Background: In cardiac arrest survivors, metabolic parameters [pH value, lactate concentration, and base deficit (BD)] are routinely added to peri-arrest factors (including age, sex, bystander cardiopulmonary resuscitation, shockable first rhythm, resuscitation duration, adrenaline dose) to enhance early outcome prediction. However, the additional value of this strategy remains unclear.Methods: We used our resuscitation database to screen all patients ≥18 years who had suffered in- or out-of-hospital cardiac arrest (IHCA, OHCA) between January 1st, 2005 and May 1st, 2019. Patients with incomplete data, without return of spontaneous circulation or treatment with sodium bicarbonate were excluded. To analyse the added value of metabolic parameters to prognosticate neurological function, we built three models using logistic regression. These models included: (1) Peri-arrest factors only, (2) peri-arrest factors plus metabolic parameters and (3) metabolic parameters only. Receiver operating characteristics curves regarding 30-day good neurological function (Cerebral Performance Category 1-2) were analysed.Results: A total of 2,317 patients (OHCA: n = 1842) were included. In patients with OHCA, model 1 and 2 had comparable predictive value. Model 3 was inferior compared to model 1. In IHCA patients, model 2 performed best, whereas both metabolic (model 3) and peri-arrest factors (model 1) demonstrated similar power. PH, lactate and BD had interchangeable areas under the curve in both IHCA and OHCA.Conclusion: Although metabolic parameters may play a role in IHCA, no additional value in the prediction of good neurological outcome could be found in patients with OHCA. This highlights the importance of accurate anamnesis especially in patients with OHCA.

背景：在心脏骤停幸存者中，代谢参数（包括pH值、乳酸浓度和碱缺失值）通常被纳入心脏骤停相关因素（包括年龄、性别、目击者的心肺复苏、可除颤的首个心律、复苏时间和肾上腺素剂量）以增强早期预后预测。然而，此策略的额外价值尚不明确。方法：我们利用我们的复苏数据库筛选了2005年1月1日至2019年5月1日之间所有≥18岁的院内或院外心脏骤停（IHCA，OHCA）患者。排除数据不完整、无自发性循环恢复或接受碳酸氢钠治疗的患者。为了分析代谢参数在预测神经功能预后方面的附加价值，我们构建了三个基于逻辑回归的模型。这些模型包括：（1）仅心脏骤停相关因素，（2）心脏骤停相关因素加代谢参数，以及（3）仅代谢参数。分析了关于30天良好神经功能（脑功能分类1-2级）的受试者工作特征曲线。结果：共有2,317名患者（OHCA：n = 1,842）被纳入研究。在OHCA患者中，模型1和2的预测价值相当。与模型1相比，模型3的表现较差。在IHCA患者中，模型2表现最佳，而代谢参数（模型3）和心脏骤停相关因素（模型1）显示出了相似的力量。在IHCA和OHCA患者中，pH值、乳酸和碱缺失值的曲线下面积可以互换。结论：尽管代谢参数可能在IHCA中发挥作用，但在OHCA患者中并未发现其对良好神经功能预后的预测具有额外价值。这突出了在OHCA患者中准确病史的重要性。