Predictive accuracy of biomarkers for survival among cardiac arrest patients with hypothermia: a prospective observational cohort study in Japan

• Published in: Scandinavian journal of trauma, resuscitation and emergency medicine Vol. 28; no. 1; pp. 75 - 9
• Main Authors: Okada, Yohei, Kiguchi, Takeyuki, Irisawa, Taro, Yoshiya, Kazuhisa, Yamada, Tomoki, Hayakawa, Koichi, Noguchi, Kazuo, Nishimura, Tetsuro, Ishibe, Takuya, Yagi, Yoshiki, Kishimoto, Masafumi, Shintani, Hiroshi, Hayashi, Yasuyuki, Sogabe, Taku, Morooka, Takaya, Sakamoto, Haruko, Suzuki, Keitaro, Nakamura, Fumiko, Nishioka, Norihiro, Matsuyama, Tasuku, Matsui, Satoshi, Shimazu, Takeshi, Koike, Kaoru, Kawamura, Takashi, Kitamura, Tetsuhisa, Iwami, Taku
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.08.2020; Springer Nature B.V; BioMed Central; BMC
• Subjects: Accuracy; Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Biological markers; Biomarkers; Biomarkers - blood; Blood tests; Body temperature; Cardiac arrest; Cardiac patients; Cohort analysis; Cohort Studies; Critical care; Diagnosis; Emergency medical care; Extracorporeal membrane oxygenation; Female; Humans; Hydrogen-Ion Concentration; Hypothermia; Hypothermia - mortality; Japan - epidemiology; Lactates; Lactic Acid - blood; Male; Medical care quality; Medical diagnosis; Medical prognosis; Medical research; Middle Aged; Observational studies; Original Research; Out-of-hospital cardiac arrest; Out-of-Hospital Cardiac Arrest - mortality; Paramedics; Patient outcomes; Patients; Potassium; Potassium - blood; Prediction; Prognosis; Registries; Retrospective Studies; Sensitivity and Specificity; Variables; Young Adult; Japan; Out-of-hospital cardiac arrest; Prognosis; Diagnosis; Prediction; Hypothermia
• ISSN: 1757-7241; 1757-7241
• DOI: 10.1186/s13049-020-00765-2

There is limited information on the predictive accuracy of commonly used predictors, such as lactate, pH or serum potassium for the survival among out-of-hospital cardiac arrest (OHCA) patients with hypothermia. This study aimed to identify the predictive accuracy of these biomarkers for survival among OHCA patients with hypothermia. In this retrospective analysis, we analyzed the data from a multicenter, prospective nationwide registry among OHCA patients transported to emergency departments in Japan (the JAAM-OHCA Registry). We included all adult (≥18 years) OHCA patients with hypothermia (≤32.0 °C) who were registered from June 2014 to December 2017 and whose blood test results on hospital arrival were recorded. We calculated the predictive accuracy of pH, lactate, and potassium for 1-month survival. Of the 34,754 patients in the JAAM-OHCA database, we included 754 patients from 66 hospitals. The 1-month survival was 5.8% (44/754). The areas under the curve of the predictors and 95% confidence interval were as follows: pH 0.829 [0.767-0.877] and lactate 0.843 [0.793-0.882]. On setting the cutoff points of 6.9 in pH and 120 mg/dL (13.3 mmol/L) in lactate, the predictors had a high sensitivity (lactate: 0.91; pH 0.91) and a low negative likelihood ratio (lactate: 0.14; pH 0.13), which are suitable to exclude survival to 1 month. Furthermore, in additional analysis that included only the patients with potassium values available, a cutoff point of 7.0 (mmol/L) for serum potassium had high sensitivity (0.96) and a low negative likelihood ratio (0.09). This study indicated the predictive accuracy of serum lactate, pH, and potassium for 1-month survival among adult OHCA patients with hypothermia. These biomarkers may help define a more appropriate resuscitation strategy.