Abstract：
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) increases lactate levels and reduces albumin levels on admission and tends to lead to a poor neurological prognosis. In our experience, reduced cholesterol levels predict poor neurological prognosis. However, the relationship between cholesterol levels and neurological prognosis in OHCA survivors remains unclear.
METHODS: This retrospective observational study included data from January 2015 to June 2023 on 219 OHCA survivors at our intensive care unit. Patients were categorized into two groups based on cerebral functional classification (CPC) scores: Group A (CPC score of 1 or 2), including patients with a favorable neurological outcome, and Group B (CPC scores of 3 to 5), comprising those with a poor neurological outcome. We analyzed their lactate, albumin levels, and lipid profiles measured at 6 h after resuscitation. A model to predict the neurological prognosis of admission of OHCA survivors was developed.
RESULTS: Approximately 40% of the patients had favorable neurological outcomes at the 30-day follow-up. The lactate-to-albumin ratio (LAR) was significantly lower in Group A than in Group B (3.1 vs. 5.0 mmol/dag, p < 0.001). However, the albumin, total cholesterol, and high-density lipoprotein (HDL) cholesterol levels were significantly higher in Group A than in Group B (3.6 vs. 2.9 g/dL, 166.1 vs. 131.4 mg/dL, and 38.8 vs. 29.7 mg/dL, respectively, p < 0.001). Favorable neurological outcome was indicated at the following thresholds: LAR < 3.7 mmol/dag, albumin level > 3.1 g/dL, total cholesterol level > 146.4 mg/dL, and HDL-cholesterol level > 31.9 mg/dL. These findings underscore the high sensitivity and negative predictive value of the biomarkers. Furthermore, the area under the curve values for LAR, albumin, total cholesterol, and HDL-cholesterol levels were 0.70, 0.75, 0.71, and 0.71, respectively. The corresponding odds ratios were 3.37, 7.08, 3.67, and 3.94, respectively.
CONCLUSIONS: The LAR, albumin, total cholesterol, and HDL-cholesterol levels measured on admission may predict neurological prognosis in OHCA survivors. Thus, routine practice should include the measurement of these biomarkers at 6 h after resuscitation, especially in patients with a lactate level of > 5 mmol/L.
BACKGROUND: ClinicalTrials.gov ID: NCT02633358.
METHODS: This retrospective observational study included data from January 2015 to June 2023 on 219 OHCA survivors at our intensive care unit. Patients were categorized into two groups based on cerebral functional classification (CPC) scores: Group A (CPC score of 1 or 2), including patients with a favorable neurological outcome, and Group B (CPC scores of 3 to 5), comprising those with a poor neurological outcome. We analyzed their lactate, albumin levels, and lipid profiles measured at 6 h after resuscitation. A model to predict the neurological prognosis of admission of OHCA survivors was developed.
RESULTS: Approximately 40% of the patients had favorable neurological outcomes at the 30-day follow-up. The lactate-to-albumin ratio (LAR) was significantly lower in Group A than in Group B (3.1 vs. 5.0 mmol/dag, p < 0.001). However, the albumin, total cholesterol, and high-density lipoprotein (HDL) cholesterol levels were significantly higher in Group A than in Group B (3.6 vs. 2.9 g/dL, 166.1 vs. 131.4 mg/dL, and 38.8 vs. 29.7 mg/dL, respectively, p < 0.001). Favorable neurological outcome was indicated at the following thresholds: LAR < 3.7 mmol/dag, albumin level > 3.1 g/dL, total cholesterol level > 146.4 mg/dL, and HDL-cholesterol level > 31.9 mg/dL. These findings underscore the high sensitivity and negative predictive value of the biomarkers. Furthermore, the area under the curve values for LAR, albumin, total cholesterol, and HDL-cholesterol levels were 0.70, 0.75, 0.71, and 0.71, respectively. The corresponding odds ratios were 3.37, 7.08, 3.67, and 3.94, respectively.
CONCLUSIONS: The LAR, albumin, total cholesterol, and HDL-cholesterol levels measured on admission may predict neurological prognosis in OHCA survivors. Thus, routine practice should include the measurement of these biomarkers at 6 h after resuscitation, especially in patients with a lactate level of > 5 mmol/L.
BACKGROUND: ClinicalTrials.gov ID: NCT02633358.
摘要：
背景：院外心脏骤停（OHCA）会增加入院时的乳酸水平并降低白蛋白水平，并倾向于导致神经系统预后不良。根据我们的经验,胆固醇水平降低可预测神经系统预后不良。然而,OHCA幸存者中胆固醇水平与神经系统预后之间的关系尚不清楚.
方法：这项回顾性观察性研究包括2015年1月至2023年6月在我们重症监护病房的219名OHCA幸存者的数据。根据脑功能分类（CPC）评分将患者分为两组：A组（CPC评分为1或2），包括神经系统预后良好的患者，和B组（CPC得分3到5），包括那些神经学结果差的人。我们分析了它们的乳酸,白蛋白水平，和在复苏后6小时测量的血脂。建立了预测OHCA幸存者入院的神经预后的模型。
结果：大约40%的患者在30天的随访中具有良好的神经系统转归。A组的乳酸与白蛋白比值（LAR）明显低于B组（3.1vs.5.0mmol/dag,p<0.001)。然而,白蛋白,总胆固醇,A组高密度脂蛋白（HDL）胆固醇水平明显高于B组（3.6vs.2.9g/dL,166.1vs.131.4mg/dL,和38.8vs.29.7mg/dL,分别,p<0.001)。在以下阈值显示了良好的神经系统结局：LAR<3.7mmol/dag，白蛋白水平>3.1g/dL，总胆固醇水平>146.4mg/dL，HDL-胆固醇水平>31.9mg/dL。这些发现强调了生物标志物的高灵敏度和阴性预测值。此外，LAR的曲线下面积值，白蛋白,总胆固醇,HDL-胆固醇水平分别为0.70、0.75、0.71和0.71。相应的比值比分别为3.37、7.08、3.67和3.94。
结论：LAR，白蛋白,总胆固醇,入院时测量的HDL-胆固醇水平可以预测OHCA幸存者的神经系统预后。因此，常规实践应包括在复苏后6小时测量这些生物标志物，尤其是乳酸水平>5mmol/L的患者。
背景：ClinicalTrials.govID：NCT02633358。
方法：这项回顾性观察性研究包括2015年1月至2023年6月在我们重症监护病房的219名OHCA幸存者的数据。根据脑功能分类（CPC）评分将患者分为两组：A组（CPC评分为1或2），包括神经系统预后良好的患者，和B组（CPC得分3到5），包括那些神经学结果差的人。我们分析了它们的乳酸,白蛋白水平，和在复苏后6小时测量的血脂。建立了预测OHCA幸存者入院的神经预后的模型。
结果：大约40%的患者在30天的随访中具有良好的神经系统转归。A组的乳酸与白蛋白比值（LAR）明显低于B组（3.1vs.5.0mmol/dag,p<0.001)。然而,白蛋白,总胆固醇,A组高密度脂蛋白（HDL）胆固醇水平明显高于B组（3.6vs.2.9g/dL,166.1vs.131.4mg/dL,和38.8vs.29.7mg/dL,分别,p<0.001)。在以下阈值显示了良好的神经系统结局：LAR<3.7mmol/dag，白蛋白水平>3.1g/dL，总胆固醇水平>146.4mg/dL，HDL-胆固醇水平>31.9mg/dL。这些发现强调了生物标志物的高灵敏度和阴性预测值。此外，LAR的曲线下面积值，白蛋白,总胆固醇,HDL-胆固醇水平分别为0.70、0.75、0.71和0.71。相应的比值比分别为3.37、7.08、3.67和3.94。
结论：LAR，白蛋白,总胆固醇,入院时测量的HDL-胆固醇水平可以预测OHCA幸存者的神经系统预后。因此，常规实践应包括在复苏后6小时测量这些生物标志物，尤其是乳酸水平>5mmol/L的患者。
背景：ClinicalTrials.govID：NCT02633358。
