Early prognostication post-cardiac arrest can help determine appropriate medical management and help evaluate effectiveness of post-arrest interventions. The Pittsburgh Cardiac Arrest Category (PCAC) severity score is a 4-level illness severity score found to strongly predict patient outcomes in both in- (IHCA) and out-of-hospital cardiac arrests (OHCA). We aimed to validate the PCAC severity score in an external cohort of cardiac arrest patients.

Methods

We retrospectively assigned PCAC scores to both IHCA and OHCA patients treated by our hypothermia team from July 1, 2009 to July 1 2016. Our primary outcome was survival to hospital discharge. Secondary outcomes were favorable functional status defined as favorable discharge disposition (home or acute rehabilitation), discharge Cerebral Performance Category (CPC); and discharge modified Rankin Scale (mRS). We tested the association of PCAC and outcomes using a multivariable adjusted logistic regression model.

Results

We included 317 subjects in our model. PCAC was strongly associated with survival I Reference; II adjusted odds ratio (OR) 0.20 95% confidence interval (CI) 0.35–0.66, III (OR 0.14 CI 0.3–0.73, p < 0.05); IV (OR 0.05 CI 0.01–0.24, p < 0.01). PCAC was similarly associated with favorable functional outcomes: favorable discharge disposition II (OR 0.12 CI 0.02–0.68), III (OR 0.19 CI 0.05–0.74, p < 0.05) IV (OR 0.05 CI 0.01–0.22, p < 0.01); favorable CPC score II (OR 0.25 CI 0.06–1.03), III (OR 0.14 CI 0.03–0.57, p < 0.01), IV (OR 0.05 CI 0.01–0.20, p < 0.01) and favorable mRS (OR 0.47 CI (0.33–0.68)).

Conclusion

Early (<6 h post-arrest) PCAC severity scoring strongly predicts patient outcomes from cardiac arrest in both OHCA and IHCA.

中文翻译：

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匹兹堡心脏骤停类别疾病严重程度评分的外部验证

心脏骤停后的早期预测有助于确定适当的医疗管理，并有助于评估心脏骤停后干预措施的有效性。匹兹堡心脏骤停类别 (PCAC) 严重程度评分是一个 4 级疾病严重程度评分，被发现可强烈预测院内 (IHCA) 和院外心脏骤停 (OHCA) 的患者结局。我们旨在验证心脏骤停患者的外部队列中的 PCAC 严重程度评分。

方法

我们对 2009 年 7 月 1 日至 2016 年 7 月 1 日期间接受我们的低温治疗团队治疗的 IHCA 和 OHCA 患者的 PCAC 评分进行了回顾性分配。我们的主要结果是生存至出院。次要结果是良好的功能状态，定义为良好的出院处置（家庭或急性康复）、出院脑性能类别（CPC）；和出院改良Rankin量表（mRS）。我们使用多变量调整逻辑回归模型测试了 PCAC 和结果的关联。

结果

我们的模型中包括了 317 个科目。PCAC 与生存 I Reference 密切相关；II 调整优势比 (OR) 0.20 95% 置信区间 (CI) 0.35–0.66, III (OR 0.14 CI 0.3–0.73, p  < 0.05)；IV (OR 0.05 CI 0.01–0.24, p  < 0.01)。PCAC 与良好的功能结果相似：良好的出院处置 II (OR 0.12 CI 0.02–0.68)、III (OR 0.19 CI 0.05–0.74, p  < 0.05) IV (OR 0.05 CI 0.01–0.22, p  < 0.01)；有利的 CPC 评分 II (OR 0.25 CI 0.06–1.03)、III (OR 0.14 CI 0.03–0.57, p  < 0.01)、IV (OR 0.05 CI 0.01–0.20, p  < 0.01) 和有利的 mRS (OR 0.47 CI (0.33– 0.68))。

结论

早期（心脏骤停后 6 小时）PCAC 严重程度评分强烈预测 OHCA 和 IHCA 中心脏骤停的患者结局。