A retrospective study on prediction of neurological outcome in cardiac arrest patients of out-hospital

doi:10.16138/j.1673-6087.2022.06.005

Abstract

Abstract:

Objective To investigate the predictive power of neurological examination results and serum neuron specific enolase(NSE) concentration for the neurological outcome of cardiac arrest patients. Methods All cardiac arrest patients were retrospectively analyzed. They were divided into good outcome group [cerebral performance category (CPC)≤2] and poor outcome group (CPC≥3) according to CPC scores on day 30. According to Glasgow coma scale (GCS), serum NSE concentration, pupil light reflex, eye opening score (eGCS), limb movement score (mGCS) and the sum of two (emGCS) were compared between two groups. Repeated measures were used to evaluate the correlation, and Logistic regression analysis was used to explore the univariate and multivariate predictors. Results The serum NSE concentration in poor outcome group was significantly higher than that in good outcome group (P<0.01). The change of mGCS (Δ mGCS) and emGCS (Δ emGCS) within first 3 days in good outcome group was significantly higher than that in poor outcome group (P<0.05). Repeated measures ANOVA showed eGCS, mGCS and emGCS were significantly correlated with CPC grades(P<0.001). The analysis of generalized linear mixed model showed there was a significant correlation between absent of pupillary light reflex and poor neurological outcome (P=0.002). The eGCS, mGCS and emGCS in first 3 days, and presence of pupil light reflex on the second and third day, Δ mGCS, Δ emGCS and serum NSE levels were univariate predictors (P<0.05). Male and mGCS on day 3 were multivariate predictors (P<0.05). Conclusions The combination of male and mGCS on the 3rd day could be used to predict the poor neurological outcome in cardiac arrest patients.

Key words: Cardiac arrest, Neurological examination, Neuron specific enolase, Prognosis, Neurological function

CLC Number:

R541.78

LI Yongde, WANG Yang, LI Xiang, LI Wenjie, XIE Di, JIANG Shaowei, GE Xiaoli, WANG Hairong, GAO Chengjin, PAN Shuming. A retrospective study on prediction of neurological outcome in cardiac arrest patients of out-hospital[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(06): 447-452.

Figures/Tables 7

References 20

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指标	预后良好组（n=30）	预后不良组（n=21）	P
女性	17 (56.67)	7 (33.33)	0.15
年龄（岁）	68.50±17.21	63.57±15.94	0.31
糖尿病	11 (36.67)	6 (28.57)	0.76
高血压	18 (60.00)	11 (52.38)	0.77
冠心病	17 (56.67)	12 (57.14)	1.00
电复律	6 (20.00)	4 (19.05)	1.00
多巴胺	20 (66.67)	15 (71.43)	0.77
去甲肾上腺素	10 (33.33)	6 (28.57)	0.77
ECMO	0 (0)	1 (4.76)	0.41
急性冠脉综合征	8 (26.67)	9 (42.86)	0.25
肺栓塞	2 (6.67)	1 (4.76)	1.00
窒息	3 (10.00)	1 (4.76)	0.63
重症心肌炎	1 (3.33)	1 (4.76)	1.00
重症肺炎	8 (26.67)	6 (28.57)	1.00
中毒	2 (6.67)	1 (4.76)	1.00
其他	6 (20.00)	2 (9.52)	0.45

项目	预后良好组（n=30）	预后不良组（n=21）	P
NSE（μg/L）	12.76 [10.60，16.61]	23.50 [14.44，33.12]	0.004
ΔeGCS（分）	0.00 [0.00，1.00]	0.00 [0.00，0.00]	0.335
ΔmGCS（分）	0.00 [0.00，1.00]	0.00 [0.00，0.00]	0.005
ΔemGCS（分）	1.00 [0.00，2.00]	0.00 [0.00，0.00]	0.019

参数	效应	F	P
eGCS	时间	14.117	<0.001
	分组	29.868	<0.001
	时间-分组	0.660	0.498
mGCS	时间	13.365	<0.001
	分组	32.477	<0.001
	时间-分组	7.340	0.001
emGCS	时间	20.761	<0.001
	分组	32.340	<0.001
	时间-分组	5.169	0.018
PLR	时间	0.068	0.934
	分组	9.527	0.002
	时间-分组	1.36	0.26

项目	预后良好组（n=30）			预后不良组（n=21）
项目	第1天	第2天	第3天	第1天	第2天	第3天
eGCS（分）	3.40±0.77	3.63±0.77^2）	3.77±0.63^2）3）	2.00±1.18	2.14±1.28	2.24±1.30^1）
mGCS（分）	4.13±1.11	4.57±1.19^2）	4.73±1.20^2）	2.29±1.55	2.33±1.56	2.38±1.63
emGCS（分）	7.53±1.81	8.20±1.86^2）	8.50±1.76^2）4）	4.29±2.72	4.48±2.80^1）	4.62±2.91^1）
存在PLR	28（93.33）	29（96.67）	29（96.67）	16（76.19）	13（61.90）	11（52.38）

模型	预测指标	OR	95%CI	P
单因素分析	第1天不存在PLR	4.375	0.759~25.204	0.099
	低eGCS	0.282	0.142~0.558	<0.001
	低mGCS	0.389	0.232~0.653	<0.001
	低emGCS	0.573	0.424~0.776	<0.001
	第2天不存在PLR	17.846	2.019~157.771	0.010
	低eGCS	0.304	0.162~0.573	<0.001
	低mGCS	0.359	0.209~0.616	<0.001
	低emGCS	0.565	0.420~0.761	<0.001
	第3天不存在PLR	26.364	3.011~230.815	0.003
	低eGCS	0.241	0.107~0.544	0.001
	低mGCS	0.375	0.227~0.621	0.000
	低emGCS	0.552	0.403~0.756	<0.001
	ΔeGCS	0.540	0.155~1.882	0.333
	ΔmGCS	0.143	0.030~0.690	0.015
	ΔemGCS	0.422	0.190~0.935	0.034
	NSE	1.081	1.002~1.165	0.044
	男性	2.615	0.820~8.339	0.100
	高龄	0.982	0.949~1.016	0.301
	糖尿病	1.447	0.435~4.821	0.547
	高血压	1.364	0.442~4.203	0.589
	冠心病	0.981	0.318~3.025	0.973
	可除颤心律	1.062	0.260~4.350	0.933
	ECMO	0.000	0.000	1.000
多因素分析	男性	9.667	1.285~72.727	0.028
	第3天mGCS	0.281	0.138~0.571	<0.001