Ion shift index as a promising prognostic indicator in adult patients resuscitated from cardiac arrest

• Published in: Resuscitation Vol. 137; pp. 116 - 123
• Main Authors: Lee, Hyoung Youn, Jung, Yong Hun, Jeung, Kyung Woon, Lee, Byung Kook, Youn, Chun Song, Mamadjonov, Najmiddin, Kim, Jin Woong, Heo, Tag, Min, Yong Il
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.04.2019
• Subjects: Aged; Arrest; Biomarkers - blood; Calcium - blood; Cardiopulmonary Resuscitation; Electrolytes; Electrolytes - blood; Female; Heart; Heart Arrest - blood; Heart Arrest - therapy; Humans; Magnesium - blood; Male; Middle Aged; Phosphates - blood; Potassium - blood; Predictive Value of Tests; Prognosis; Republic of Korea; Retrospective Studies; Republic of Korea; eGFR; Heart; Arrest; Prognosis; CPR; NRI; CI; ROC; ECF; TTM; ICF; AUC; IDI; OHCA; ROS; CPC; Electrolytes; WLST; IHCA
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2019.02.020

Several studies reported that disturbances in cellular ion homeostasis occur following ischaemia, the magnitude of which was proportional to illness severity. The changes in serum electrolyte levels following ischaemia were minor compared with the changes in ion concentrations in the extracellular fluid. To amplify the serum electrolyte changes, we devised a new index (ion shift index), which could be calculated using commonly measured serum electrolyte levels, and explored its prognostic value in adult cardiac arrest patients. This retrospective observational study included adult cardiac arrest survivors treated at a tertiary university hospital between January 2014 and December 2017. Using the first available serum electrolyte levels, the ion shift index was calculated as follows: ion shift index = (potassium + phosphate + magnesium) / calcium. The primary outcome was poor outcome at hospital discharge (cerebral performance categories 3–5). The area under the receiver operating characteristic curve (AUC) of ion shift index for predicting poor outcome was 0.878 (95% confidence interval [CI], 0.849–0.907). The AUC of ion shift index was greater than those of individual electrolytes (all p < 0.001). In multivariate analysis, higher ion shift index levels were independently associated with poor outcome (odds ratio, 2.916; 95% CI, 1.798–4.730; p < 0.001). The AUC of multivariate model including ion shift index was greater than that of multivariate model after excluding ion shift index (p =  0.007). Our results suggest that the ion shift index can be helpful in the early prognostication of adult cardiac arrest patients.