Development and validation of early prediction for neurological outcome at 90 days after return of spontaneous circulation in out-of-hospital cardiac arrest,Resuscitation

当前位置： X-MOL 学术 › Resuscitation › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Development and validation of early prediction for neurological outcome at 90 days after return of spontaneous circulation in out-of-hospital cardiac arrest
Resuscitation ( IF 6.5 ) Pub Date : 2021-10-05 , DOI: 10.1016/j.resuscitation.2021.09.027
Norihiro Nishioka ₁ , Daisuke Kobayashi ₂ , Takeyuki Kiguchi ₃ , Taro Irisawa ₄ , Tomoki Yamada ₅ , Kazuhisa Yoshiya ₆ , Changhwi Park ₇ , Tetsuro Nishimura ₈ , Takuya Ishibe ₉ , Yoshiki Yagi ₁₀ , Masafumi Kishimoto ₁₁ , Sung-Ho Kim ₁₂ , Yasuyuki Hayashi ₁₃ , Taku Sogabe ₁₄ , Takaya Morooka ₁₅ , Haruko Sakamoto ₁₆ , Keitaro Suzuki ₁₇ , Fumiko Nakamura ₁₈ , Tasuku Matsuyama ₁₉ , Yohei Okada ₁ , Satoshi Matsui ₂₀ , Satoshi Yoshimura ₁ , Shunsuke Kimata ₁ , Shunsuke Kawai ₁ , Yuto Makino ₁ , Tetsuhisa Kitamura ₂₀ , Taku Iwami ₂ ,

Affiliation

Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan.
Kyoto University Health Services, Kyoto, Japan.
Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan.
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan.
Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan.
Department of Emergency Medicine, Tane General Hospital, Osaka, Japan.
Department of Critical Care Medicine, Osaka City University, Osaka, Japan.
Department of Emergency and Critical Care Medicine, Kindai University School of Medicine, Osaka-Sayama, Japan.
Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan.
Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-Osaka, Japan.
Senshu Trauma and Critical Care Center, Osaka, Japan.
Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan.
Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan.
Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan.
Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, Osaka, Japan.
Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan.
Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.

Aim

To develop and validate a model for the early prediction of long-term neurological outcome in patients with non-traumatic out-of-hospital cardiac arrest (OHCA).

Methods

We analysed multicentre OHCA registry data of adult patients with non-traumatic OHCA who experienced return of spontaneous circulation (ROSC) and had been admitted to the intensive care unit between 2013 and 2017. We allocated 1329 (2013–2015) and 1025 patients (2016–2017) to the derivation and validation sets, respectively. The primary outcome was the dichotomized cerebral performance category (CPC) at 90 days, defined as good (CPC 1–2) or poor (CPC 3–5). We developed 2 models: model 1 included variables without laboratory data, and model 2 included variables with laboratory data available immediately after ROSC. Logistic regression with least absolute shrinkage and selection operator regularization was employed for model development. Measures of discrimination, accuracy, and calibration (C-statistics, Brier score, calibration plot, and net benefit) were assessed in the validation set.

Results

The C-statistic (95% confidence intervals) of models 1 and 2 in the validation set was 0.947 (0.930–0.964) and 0.950 (0.934–0.966), respectively. The Brier score of models 1 and 2 in the validation set was 0.0622 and 0.0606, respectively. The calibration plot showed that both models were well-calibrated to the observed outcome. Decision curve analysis indicated that model 2 was similar to model 1.

Conclusion

The prediction tool containing detailed in-hospital information showed good performance for predicting neurological outcome at 90 days immediately after ROSC in patients with OHCA.

中文翻译：

院外心脏骤停患者自主循环恢复后 90 天神经功能早期预测的开发和验证

目标

开发和验证用于早期预测非创伤性院外心脏骤停 (OHCA) 患者长期神经系统结果的模型。

方法

我们分析了 2013 年至 2017 年间经历自主循环恢复 (ROSC) 并入住重症监护病房的非创伤性 OHCA 成年患者的多中心 OHCA 登记数据。我们分配了 1329 名（2013 年至 2015 年）和 1025 名患者（2016 年） –2017) 分别用于推导和验证集。主要结果是 90 天时的二分大脑表现类别 (CPC)，定义为好 (CPC 1-2) 或差 (CPC 3-5)。我们开发了 2 个模型：模型 1 包括没有实验室数据的变量，模型 2 包括在 ROSC 后立即可用的实验室数据的变量。模型开发采用具有最小绝对收缩和选择算子正则化的逻辑回归。辨别力、准确性和校准的措施（C 统计量、Brier 分数、校准图、

结果

验证集中模型 1 和 2 的 C 统计量（95% 置信区间）分别为 0.947（0.930–0.964）和 0.950（0.934–0.966）。验证集中模型 1 和 2 的 Brier 分数分别为 0.0622 和 0.0606。校准图表明，两种模型都很好地校准到观察到的结果。决策曲线分析表明模型 2 与模型 1 相似。