External validation of the simple NULL-PLEASE clinical score in predicting outcomes of out-of-hospital cardiac arrest in the Danish population - A nationwide registry-based study.

Autor: Byrne C; Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. Electronic address: christina.aagaard@sund.ku.dk., Barcella CA; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark; Department of Internal Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark., Krogager ML; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Pareek M; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark., Ringgren KB; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Andersen MP; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark., Mills EHA; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Wissenberg M; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark., Folke F; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark; Copenhagen EMS Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark., Gislason G; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark., Køber L; Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark., Lippert F; Copenhagen EMS Services, Copenhagen, Denmark., Kjærgaard J; Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark., Hassager C; Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark., Torp-Pedersen C; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark., Kragholm K; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Lip GYH; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2022 Nov; Vol. 180, pp. 128-136. Date of Electronic Publication: 2022 Aug 22.
DOI: 10.1016/j.resuscitation.2022.08.009
Abstrakt: Aim: The NULL-PLEASE score (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood pH < 7.2, Lactate > 7.0 mmol/L, End-stage renal disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) may identify patients with out-of-hospital cardiac arrest (OHCA) unlikely to survive. We aimed to validate the NULL-PLEASE score in a nationwide setting.
Methods: We used Danish nationwide registry data from 2001 to 2019 and identified OHCA survivors with return of spontaneous circulation (ROSC) or ongoing cardiopulmonary resuscitation at hospital arrival. The primary outcome was 1-day mortality. Secondary outcomes were 30-day mortality and the combined outcome of 1-year mortality or anoxic brain damage. The risks of outcomes were estimated using logistic regression with a NULL-PLEASE score of 0 as reference (range 0-14). The predictive ability of the score was examined using the area under the receiver operating characteristics (AUC ROC ) curve.
Results: A total of 3,881 patients were included in the analyses. One-day mortality was 35%, 30-day mortality was 61%, and 68% experienced the combined outcome. For a NULL-PLEASE score ≥9 (n = 244) the absolute risks were: 1-day mortality: 80.7% (95% confidence interval [CI]: 75.8-85.7%); 30-day mortality: 98.0% (95% CI: 96.2-99.7%); and the combined outcome: 98.4% (95% CI: 96.8-100.0%). Corresponding AUC ROC values were 0.800 (95% CI: 0.786-0.814) for 1-day mortality, 0.827 (95% CI: 0.814-0.840) for 30-day mortality, and 0.828 (95% CI: 0.815-0.841) for the combined outcome.
Conclusions: In a nationwide OHCA-cohort, AUC ROC values for the predictive ability of NULL-PLEASE were high for all outcomes. However, some survived even with high NULL-PLEASE scores.
Competing Interests: Conflicts of interest Dr. Christina Byrne: Speaker’s Fee: Bayer. Dr. Jesper Kjærgaard. Research grant from the Novo Nordisk Foundation NNF17OC0028706 outside the present manuscript. Dr. Manan Pareek: Advisory Board: AstraZeneca, Janssen-Cilag; Speaker’s Fee: AstraZeneca, Bayer, Boehringer Ingelheim, Janssen-Cilag. For all other authors: None
(Copyright © 2022. Published by Elsevier B.V.)
Databáze: MEDLINE
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