Comparison of four clinical risk scores in comatose patients after out-of-hospital cardiac arrest
Language English Country Ireland Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
37634862
DOI
10.1016/j.resuscitation.2023.109949
PII: S0300-9572(23)00263-0
Knihovny.cz E-resources
- Keywords
- Out-of-hospital cardiac arrest, Outcome, Outcome prediction, Risk prediction, Risk score,
- MeSH
- Cardiopulmonary Resuscitation * MeSH
- Coma diagnosis etiology therapy MeSH
- Humans MeSH
- Prognosis MeSH
- Risk Factors MeSH
- Hypothermia, Induced * MeSH
- Out-of-Hospital Cardiac Arrest * therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND AND AIMS: Several different scoring systems for early risk stratification after out-of-hospital cardiac arrest have been developed, but few have been validated in large datasets. The aim of the present study was to compare the well-validated Out-of-hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP)-scores to the less complex MIRACLE2- and Target Temperature Management (TTM)-scores. METHODS: This was a post-hoc analysis of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Missing data were handled by multiple imputation. The primary outcome was discriminatory performance assessed as the area under the receiver operating characteristics-curve (AUROC), with the outcome of interest being poor functional outcome or death (modified Rankin Scale 4-6) at 6 months after OHCA. RESULTS: Data on functional outcome at 6 months were available for 1829 cases, which constituted the study population. The pooled AUROC for the MIRACLE2-score was 0.810 (95% CI 0.790-0.828), 0.835 (95% CI 0.816-0.852) for the TTM-score, 0.820 (95% CI 0.800-0.839) for the CAHP-score and 0.770 (95% CI 0.748-0.791) for the OHCA-score. At the cut-offs needed to achieve specificities >95%, sensitivities were <40% for all four scoring systems. CONCLUSIONS: The TTM-, MIRACLE2- and CAHP-scores are all capable of providing objective risk estimates accurate enough to be used as part of a holistic patient assessment after OHCA of a suspected cardiac origin. Due to its simplicity, the MIRACLE2-score could be a practical solution for both clinical application and risk stratification within trials.
Adult Critical Care University Hospital of Wales Cardiff UK
Anaesthesia and Intensive Care Department of Surgical Sciences Uppsala University Uppsala Sweden
Cochin University Hospital Paris France
Department of Clinical Sciences Cardiology Lund University Skåne University Hospital Lund Sweden
Department of Intensive Care Medicine Bern University Hospital University of Bern Bern Switzerland
Department of Intensive Care University Hospitals Bristol and Weston Bristol UK
Institute of Intensive Care Medicine University Hospital Zurich Zurich Switzerland
References provided by Crossref.org
