C‐GRApH: A Validated Scoring System for Early Stratification of Neurologic Outcome After Out‐of‐Hospital Cardiac Arrest Treated With Targeted Temperature Management
| Autor: | Michelle C. Johansen, Mark P Adams, Lori Griffiths, Ralph Matar, Matthew Gottbrecht, Lawrence W. Gimple, Katherine L. Bidwell, Venu Menon, Alex M. Parker, Kyle B. Enfield, Steven P. Dunn, Erich L. Kiehl |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Resuscitation Scoring system medicine.medical_treatment resuscitation 030204 cardiovascular system & hematology Targeted temperature management Resuscitation Science targeted temperature management Sudden Cardiac Death Hypothermia induced Out of hospital cardiac arrest 03 medical and health sciences 0302 clinical medicine Clinical Studies Medicine Intensive care medicine Survival rate Original Research Quality and Outcomes business.industry Follow up studies 030208 emergency & critical care medicine Retrospective cohort study Cardiopulmonary Arrest Emergency medicine prognosis Cardiology and Cardiovascular Medicine business hypothermia heart arrest |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| ISSN: | 2047-9980 |
| Popis: | Background Out‐of‐hospital cardiac arrest ( OHCA ) results in significant morbidity and mortality, primarily from neurologic injury. Predicting neurologic outcome early post‐ OHCA remains difficult in patients receiving targeted temperature management. Methods and Results Retrospective analysis was performed on consecutive OHCA patients receiving targeted temperature management (32–34°C) for 24 hours at a tertiary‐care center from 2008 to 2012 (development cohort, n=122). The primary outcome was favorable neurologic outcome at hospital discharge, defined as cerebral performance category 1 to 2 (poor 3–5). Patient demographics, pre‐ OHCA diagnoses, and initial laboratory studies post‐resuscitation were compared between favorable and poor neurologic outcomes with multivariable logistic regression used to develop a simple scoring system ( C‐ GRA pH ). The C‐ GRA pH score ranges 0 to 5 using equally weighted variables: ( C ): coronary artery disease, known pre‐ OHCA ; ( G ): glucose ≥200 mg/dL; ( R ): rhythm of arrest not ventricular tachycardia/fibrillation; ( A ): age >45; ( pH ): arterial pH ≤7.0. A validation cohort (n=344) included subsequent patients from the initial site (n=72) and an external quaternary‐care health system (n=272) from 2012 to 2014. The c‐statistic for predicting neurologic outcome was 0.82 (0.74–0.90, P P C‐ GRA pH score, similar rates of favorable neurologic outcome were seen in both cohorts, 70% each for low (0–1, n=60), 22% versus 19% for medium (2–3, n=307), and 0% versus 2% for high (4–5, n=99) C‐ GRA pH scores in the development and validation cohorts, respectively. Conclusions C‐ GRA pH stratifies neurologic outcomes following OHCA in patients receiving targeted temperature management (32–34°C) using objective data available at hospital presentation, identifying patient subsets with disproportionally favorable ( C‐ GRA pH ≤1) and poor ( C‐ GRA pH ≥4) prognoses. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text