Ion shift index as a promising prognostic indicator in adult patients resuscitated from cardiac arrest
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 f...
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Published in | Resuscitation Vol. 137; pp. 116 - 123 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier B.V
01.04.2019
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Abstract | 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. |
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AbstractList | 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. BACKGROUNDSeveral 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. METHODSThis 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). RESULTSThe 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). CONCLUSIONSOur results suggest that the ion shift index can be helpful in the early prognostication of adult cardiac arrest patients. |
Author | Lee, Byung Kook Youn, Chun Song Jung, Yong Hun Lee, Hyoung Youn Jeung, Kyung Woon Heo, Tag Min, Yong Il Mamadjonov, Najmiddin Kim, Jin Woong |
Author_xml | – sequence: 1 givenname: Hyoung Youn surname: Lee fullname: Lee, Hyoung Youn organization: Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea – sequence: 2 givenname: Yong Hun surname: Jung fullname: Jung, Yong Hun organization: Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea – sequence: 3 givenname: Kyung Woon surname: Jeung fullname: Jeung, Kyung Woon email: neoneti@hanmail.net organization: Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea – sequence: 4 givenname: Byung Kook orcidid: 0000-0003-3571-9448 surname: Lee fullname: Lee, Byung Kook organization: Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea – sequence: 5 givenname: Chun Song orcidid: 0000-0002-6709-7703 surname: Youn fullname: Youn, Chun Song organization: Department of Emergency Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea – sequence: 6 givenname: Najmiddin surname: Mamadjonov fullname: Mamadjonov, Najmiddin organization: Department of Medical Science, Chonnam National University Graduate School, 160 Baekseo-ro, Donggu, Gwangju, Republic of Korea – sequence: 7 givenname: Jin Woong orcidid: 0000-0003-4725-5687 surname: Kim fullname: Kim, Jin Woong organization: Department of Radiology, Chosun University Hospital, 365 Pilmon-daero, Donggu, Gwangju, Republic of Korea – sequence: 8 givenname: Tag surname: Heo fullname: Heo, Tag organization: Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea – sequence: 9 givenname: Yong Il surname: Min fullname: Min, Yong Il organization: Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30807816$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_3390_jcm11206187 crossref_primary_10_1016_j_injury_2021_03_001 crossref_primary_10_1016_j_resuscitation_2020_12_022 crossref_primary_10_1097_MD_0000000000038773 crossref_primary_10_1089_ther_2019_0023 crossref_primary_10_3390_diagnostics13091523 crossref_primary_10_1097_SHK_0000000000002040 crossref_primary_10_5847_wjem_j_1920_8642_2023_087 crossref_primary_10_1161_JAHA_119_017625 crossref_primary_10_1186_s13054_022_04263_y |
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Keywords | eGFR Heart Arrest Prognosis CPR NRI CI ROC ECF TTM ICF AUC IDI OHCA ROS CPC Electrolytes WLST IHCA |
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Snippet | Several studies reported that disturbances in cellular ion homeostasis occur following ischaemia, the magnitude of which was proportional to illness severity.... BACKGROUNDSeveral studies reported that disturbances in cellular ion homeostasis occur following ischaemia, the magnitude of which was proportional to illness... |
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SubjectTerms | 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 |
Title | Ion shift index as a promising prognostic indicator in adult patients resuscitated from cardiac arrest |
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