Abstract 10905: A Simple Clinical Prognostication Score Can Predict the Long-Term Prognoses of the Patients with Out-Of-Hospital Cardiac Arrests in Relatively Younger Age
Background: Sudden cardiac death is a serious problem in public health and it affects >110,000 people /year in Japan. However, overall survival rate of out-of-hospital cardiac arrests (OHCAs) is still low (6.3%) and predicting factors of OHCAs are unclear. We retrospectively analyzed the clinical factors of patients with OHCAs to evaluate the prognostication score for prediction of the long-term prognoses by dividing their age.
Methods and Results: We analyzed 750 consecutive patients of OHCAs with internal cause (July/2008-June/2010). They were divided into 2 groups by the age of 70 (<70 [n=293], ≥70 [n=457]) and the clinical parameters were compared between survivors and non-survivors. In the age of <70, 1 month survivors and patients with good neurological outcome were 34 and 25. The multivariable analysis exhibited 9 independent predicting factors;1) public space where the cardiac arrests were happened (odds rate [OR]:8.0, 95%confidence interval[CI]:1.7-50.2), 2) bystander cardiopulmonary resuscitation (OR:8.0, 95%CI:1.83-47.4), 3) witnessed ventricular fibrillation/pulse-less ventricular tachycardia as the initial rhythm (OR:5.0, 95%CI:1.14-25.4), 4) return of spontaneous circulation before arrival at the hospital (OR:63.0, 95%CI:11.7-626.0), 5) presumed cardiac cause (OR:8.0, 95%CI: 1.9-57.2), 6) Glasgow coma scale≥5.0 points (OR:4.7, 95%CI:1.4-19.7), 7) pH≥7.0 (OR:5.1, 95%CI:1.7-17.0), 8) K+≤5.0mEq/l (OR:10.4, 95%CI:2.6-70.5), 9) C-reactive protein≤0.3mg/dl (OR:3.4, 95%CI: 1.1-12.3). When a prognostication score was calculated by simply adding the number of these independent predicting factors, the score >5 points well indicated survival (sensitivity 94.1%, specificity 96.9%) and good neurological outcome (sensitivity 92.0%, specificity 93.7%). In contrast in older age, survivors and patients with good neurological outcome were 10 and 5, and the prognostication score could not predict the patients' prognoses.
Conclusion: In this study, the prognostication score predicted the patients' prognoses in younger age, but it was not useful in older age. The intensive therapy for patients with OHCAs might be guided differently by considering patients' generation.
- © 2011 by American Heart Association, Inc.