Abstract 16560: Initial Thrombin-Antithrombin Levels Are Associated With Survival in Post-cardiac Arrest Patients
Objective: Cardiac arrest may result in activation of thrombogenesis that could impair microcirculation or lead to end organ failure. Elevated serum levels of thrombin-antithrombin (TAT) during CPR complexes are associated with lower likelihood of return of circulation, but it is unknown whether TAT levels are associated with development of multiple organ failure (MOF) after return of circulation. We tested the relationship between serum TAT levels, survival, and development of MOF after cardiac arrest.
Methods: Prospective cohort study of 100 in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) subjects treated in a single tertiary care center between 1/1/2007 and 5/30/2010. Clinical data (age, gender, post cardiac arrest illness severity category, location of arrest, and presenting rhythm of arrest) were recorded, and serum TAT concentrations were measured by a commercial ELISA assay at 0, 6, 12, 24, 48, and 72 hours. Outcomes were survival to 28 days or hospital discharge and development of MOF (defined as a score of ≥3 on 3 or more subscores of the sequential organ failure assessment). Multivariable logistic regression was used to describe the association between TAT, survival, and MOF.
Results: Of 100 subjects, 14 were excluded due to lack of consent (N=9) or missing blood samples (N=5). Most (58%) were male, experiencing OHCA with a primary rhythm of VF/VT (45%). Logistic regression demonstrated that initial TAT concentration was inversely associated with survival (OR 0.004, 95% CI 0.0002, 0.1, P= 0.001). Initial illness severity category 2 and gender were predictive of survival (Category 2: OR 3.98, 95% CI 1.1, 14.2, P= 0.03; gender: OR 0.223, 95% CI 0.06, 0.8, P= 0.02). TAT was not associated with MOF.
Conclusion: Elevated initial serum TAT concentration is negatively associated with survival but not MOF.
- © 2011 by American Heart Association, Inc.