Comparison of different clinical risk scores to predict long-term survival and neurological outcome in adults after cardiac arrest: results from a prospective cohort study,Annals of Intensive Care

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Comparison of different clinical risk scores to predict long-term survival and neurological outcome in adults after cardiac arrest: results from a prospective cohort study
Annals of Intensive Care ( IF 5.7 ) Pub Date : 2022-08-17 , DOI: 10.1186/s13613-022-01048-y
René Blatter ₁ , Simon A Amacher _{1,

2} , Chantal Bohren ₁ , Christoph Becker _{1,

3} , Katharina Beck ₁ , Sebastian Gross ₁ , Kai Tisljar ₂ , Raoul Sutter _{2,

4} , Stephan Marsch _{2,

4} , Sabina Hunziker _{1,

4}

Affiliation

Background

Several scoring systems have been used to predict short-term outcome in patients with out-of-hospital cardiac arrest (OHCA), including the disease-specific OHCA and CAHP (Cardiac Arrest Hospital Prognosis) scores, as well as the general severity-of-illness scores Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II). This study aimed to assess the prognostic performance of these four scores to predict long-term outcomes (≥ 2 years) in adult cardiac arrest patients.

Methods

This is a prospective single-centre cohort study including consecutive cardiac arrest patients admitted to intensive care in a Swiss tertiary academic medical centre. The primary endpoint was 2-year mortality. Secondary endpoints were neurological outcome at 2 years post-arrest assessed by Cerebral Performance Category with CPC 1–2 defined as good and CPC 3–5 as poor neurological outcome, and 6-year mortality.

Results

In 415 patients admitted to intensive care, the 2-year mortality was 58.1%, with 96.7% of survivors showing good neurological outcome. The 6-year mortality was 82.5%. All four scores showed good discriminatory performance for 2-year mortality, with areas under the receiver operating characteristics curve (AUROC) of 0.82, 0.87, 0.83 and 0.81 for the OHCA, CAHP, APACHE II and SAPS II scores. The results were similar for poor neurological outcome at 2 years and 6-year mortality.

Conclusion

This study suggests that two established cardiac arrest-specific scores and two severity-of-illness scores provide good prognostic value to predict long-term outcome after cardiac arrest and thus may help in early goals-of-care discussions.

中文翻译：

比较不同临床风险评分以预测成人心脏骤停后的长期生存和神经系统结果：一项前瞻性队列研究的结果

背景

几种评分系统已被用于预测院外心脏骤停 (OHCA) 患者的短期结果，包括疾病特异性 OHCA 和 CAHP（心脏骤停医院预后）评分，以及一般严重程度-疾病评分急性生理学和慢性健康评估 II (APACHE II) 和简化的急性生理学评分 II (SAPS II)。本研究旨在评估这四个评分的预后表现，以预测成人心脏骤停患者的长期预后（≥ 2 年）。

方法

这是一项前瞻性单中心队列研究，包括在瑞士三级学术医疗中心接受重症监护的连续心脏骤停患者。主要终点是 2 年死亡率。次要终点是根据大脑性能类别评估的逮捕后 2 年的神经系统结果，其中 CPC 1-2 定义为良好，CPC 3-5 定义为不良神经系统结果，以及 6 年死亡率。

结果

在接受重症监护的 415 名患者中，2 年死亡率为 58.1%，其中 96.7% 的幸存者表现出良好的神经系统预后。6年死亡率为82.5%。所有四个评分都显示出良好的 2 年死亡率区分性能，OHCA、CAHP、APACHE II 和 SAPS II 评分的受试者工作特征曲线下面积 (AUROC) 分别为 0.82、0.87、0.83 和 0.81。2 年和 6 年死亡率较差的神经系统结局的结果相似。