Lactate to Albumin Ratio for Predicting Clinical Outcomes after In-Hospital Cardiac Arrest
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Population
2.3. Cerebral Performance Category
2.4. Statistical Analysis
3. Results
3.1. Patients’ Characteristics
3.2. The Outcome of Patients after IHCA
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Patient Characteristics | Univariate | Multivariate | ||||
---|---|---|---|---|---|---|
OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
Age, years | 0.971 | 0.949–0.992 | 0.008 * | 0.976 | 0.935–1.009 | 0.267 |
Sex (female) | 0.864 | 0.512–1.457 | 0.583 | |||
Diabetes mellitus | 0.908 | 0.512–1.611 | 0.742 | |||
Hypertension | 0.750 | 0.409–1.376 | 0.353 | |||
CAD | 2.158 | 1.249–3.727 | 0.006 * | |||
PAD | 0.791 | 0.386–1.624 | 0.523 | |||
Chronic kidney disease | 0.739 | 0.572–0.954 | 0.020 * | |||
Charlson Comorbidity Index | 0.897 | 0.804–1.001 | 0.053 * | |||
GFR, mL/min | 1.018 | 1.008–1.028 | 0.001 * | 1.007 | 0.987–1.027 | 0.497 |
Haemoglobin, g/dL | 1.259 | 1.133–1.399 | 0.001 * | 1.246 | 1.008–1.541 | 0.042 * |
elective admission | 1.759 | 0.824–3.754 | 0.145 | |||
cardiac origin of IHCA | 2.262 | 1.346–3.800 | 0.002 * | 0.483 | 0.134–1.733 | 0.264 |
Arrest time on-hours, min | 1.614 | 0.948–2.746 | 0.078 | 2.374 | 0.711–7.926 | 0.160 |
Primary shockable rhythm | 4.425 | 2.545–7.695 | 0.001 * | 3.906 | 1.039–14.689 | 0.044 * |
Defibrillation, n (%) | 4.049 | 2.341–7.002 | 0.001 * | |||
Number of epinephrine applications, n | 0.569 | 0.472–0.686 | 0.001 * | |||
Time to ROSC | 0.928 | 0.903–0.953 | 0.001 * | 0.442 | 0.953–1.021 | 0.442 |
ECLS | 1.717 | 0.450–6.558 | 0.429 | |||
PCI after ROSC | 2.550 | 1.430–4.549 | 0.002 * | |||
Lactate after ROSC | 0.776 | 0.720–0.835 | 0.001 * | |||
Albumin after ROSC | 2.213 | 1.535–3.190 | 0.001 * | |||
LAR after ROSC | 0.498 | 0.407–0.610 | 0.001 * | 0.616 | 0.422–0.899 | 0.012 * |
Troponin after ROSC | 1.000 | 1.000–1.000 | 0.113 | |||
NSE peak level | 0.983 | 0.974–0.993 | 0.001 * | 0.991 | 0.980–1.012 | 0.119 |
Appendix B
Patient Characteristics | Univariate | Multivariate | ||||
---|---|---|---|---|---|---|
OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
Age, years | 0.963 | 0.940–0.987 | 0.002 * | 0.964 | 0.920–1.011 | 0.136 |
Sex (female) | 0.882 | 0.483–1.609 | 0.682 | |||
Diabetes mellitus | 0.677 | 0.339–1.353 | 0.269 | |||
Hypertension | 0.660 | 0.339–1.286 | 0.222 | |||
CAD | 1.281 | 0.695–2.364 | 0.269 | |||
PAD | 0.657 | 0.273–1.582 | 0.349 | |||
Chronic kidney disease | 0.662 | 0.484–0.904 | 0.010 * | |||
Charlson Comorbidity Index | 0.836 | 0.734–0.952 | 0.007 * | 0.939 | 0.731–1.207 | 0.625 |
GFR, mL/min | 1.017 | 1.006–1.029 | 0.002 * | 0.998 | 0.977–1.020 | 0.857 |
Haemoglobin, g/dL | 1.188 | 1.061–1.331 | 0.003 * | 1.186 | 0.969–1.453 | 0.098 |
elective admission | 1.503 | 0.665–3.400 | 0.328 | |||
cardiac origin of IHCA | 2.162 | 1.188–3.934 | 0.012 * | 1.987 | 0.636–6.155 | 0.239 |
Arrest time on-hours | 1.373 | 0.745–2.530 | 0.309 | 2.159 | 0.682–6.831 | 0.190 |
Primary shockable rhythm | 1.603 | 0.889–2.888 | 0.116 | 0.698 | 0.218–2.230 | 0.544 |
Defibrillation, n (%) | 1.514 | 0.841–2.726 | 0.167 | |||
Number of epinephrine applications, n | 0.631 | 0.512–0.776 | 0.001 * | |||
Time to ROSC | 0.951 | 0.925–0.978 | 0.001 * | 1.016 | 0.983–1.050 | 0.351 |
ECLS | 0.839 | 0.171–4.193 | 0.429 | |||
Lactate after ROSC | 0.800 | 0.736–0.870 | 0.001 * | |||
Albumin after ROSC | 2.133 | 1.412–3.224 | 0.001 * | |||
LAR after ROSC | 0.577 | 0.444–0.698 | 0.001 * | 0 | 0.540–0.997 | 0.048 * |
Troponine after ROSC | 1.000 | 1.000–1.000 | 0.304 | |||
NSE peak level | 0.989 | 0.979–0.999 | 0.034 * | 0.992 | 0.981–1.003 | 0.170 |
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Patient Characteristics | Complete Cohort (n = 244) | Q1 Group (n = 61) | Q2 Group (n = 61) | Q3 Group (n = 61) | Q4 Group (n = 61) | p-Value |
---|---|---|---|---|---|---|
LAR, median | 2.47 (0.96, 4.17) | 0.54 (0.38, 0.70) | 1.64 (1.22, 2.12) | 3.39 (2.71, 3.78) | 5.93 (5.16, 8.19) | <0.001 |
Lactate after ROSC, median in mmol/L | 7.0 (3.3, 11.3) | 1.7 (1.2, 2.4) | 5.0 (4.2, 6.5) * | 9.3 (7.7, 10.9) *# | 14.0 (12.3, 19.3) *#° | <0.001 |
Albumin, median in g/dL | 3.0 (2.4, 3.6) | 3.7 (3.0, 3.9) | 3.3 (2.9, 3.7) | 2.8 (2.5, 3.5) *# | 2.3 (1.8, 2.8) *#° | <0.001 |
Age, median, years | 73 (63, 80) | 73 (65, 81) | 75 (60, 81) | 71 (64, 80) | 71 (60, 81) | 0.856 |
Women/male, n/n (%/%) | 94/150 (39/61) | 23/38 (38/62) | 20/41 (33/67) | 22/39 (36/64) | 29/32 (48/52) | 0.374 |
CAD, n (%) | 150 (61) | 37 (61) | 47 (77) | 37 (61) | 33 (54) | 0.057 |
PAD, n (%) | 37 (15) | 7 (11) | 9 (15) | 13 (21) | 8 (13) | 0.450 |
Arterial hypertension, n (%) | 190 (78) | 46 (75) | 51 (84) | 46 (75) | 47 (77) | 0.656 |
Diabetes mellitus, n (%) | 66 (27) | 16 (26) | 16 (26) | 16 (26) | 18 (30) | 0.969 |
Liver cirrhosis, n (%) | 9 (4) | 1 (2) | 4 (7) | 3 (5) | 1 (2) | 0.374 |
Hepatis B or C, n (%) | 4 (2) | 0 (0) | 1 (2) | 2 (3) | 1 (2) | |
GFR, median, mL/min | 45 (27, 70) | 44 (32, 74) | 49 (23, 79) | 47 (34, 77) | 40 (24, 54) | 0.205 |
Charlson Comorbidity Index | 5 (4, 7) | 5 (4, 6) | 5 (4, 7) | 6 (4, 8) | 5 (4, 7) | 0.236 |
Hemoglobin, median, g/dL | 10.9 (9.1, 13.0) | 12.2 (9.8, 13.9) | 11.4 (9.9, 13.9) | 10.4 (8.7, 12.6) * | 9.7 (7.9, 11.1) *# | <0.001 |
C-reactive protein, median, mg/dL | 3.2 (0.8, 8.9) | 1.8 (0.6, 5.4) | 2.2 (0.6, 8.9) | 4.1 (1.2, 9.3) * | 5.1 (1.4, 11.6) * | 0.005 |
Elective admission, n (%) | 31 (13) | 11 (18) | 6 (10) | 11 (18) | 3 (5) | 0.075 |
Admission diagnosis | ||||||
Pneumonia, n (%) | 25 (10) | 5 (8) | 3 (5) | 13 (21) | 4 (7) | |
Acute heart failure, n (%) | 21 (9) | 4 (7) | 5 (8) | 5 (8) | 7 (11) | |
Acute coronary syndrome, n (%) | 52 (21) | 12 (20) | 20 (33) | 10 (16) | 10 (16) | |
Acute kidney failure, n (%) | 14 (6) | 5 (8) | 2 (3) | 2 (3) | 5 (8) | |
Cardiac arrhythmia, n (%) | 19 (8) | 3 (5) | 3 (5) | 4 (7) | 9 (15) | |
Gastrointestinal, n (%) | 15 (6) | 4 (7) | 3 (5) | 4 (7) | 4 (7) | |
Sepsis, n (%) | 8 (3) | 4 (7) | 2 (3) | 2 (3) | 0 (0) | |
Malignancy, n (%) | 25 (10) | 10 (16) | 6 (10) | 3 (5) | 6 (10) | |
Neurology, n (%) | 21 (9) | 3 (5) | 3 (5) | 8 (13) | 7 (11) | |
Peripheral artery disease, n (%) | 2 (1) | 1 (2) | 1 (2) | 0 (0) | 0 (0) | |
Pulmonary embolism, n (%) | 3 (1) | 1 (2) | 2 (3) | 0 (0) | 0 (0) | |
Other, n (%) | 40 (16) | 9 (15) | 11 (18) | 10 (16) | 10 (16) | |
Cardiac arrest characteristics | ||||||
Non-cardiac origin of IHCA, n (%) | 122 (50) | 26 (43) | 26 (43) | 34 (56) | 36 (59) | 0.142 |
Arrest time off-hours, n (%) | 93 (38) | 20 (33) | 25 (41) | 20 (33) | 28 (46) | 0.355 |
Patient Characteristics | Complete Cohort (n = 244) | Q1 Group (n = 61) | Q2 Group (n = 61) | Q3 Group (n = 61) | Q4 Group (n = 61) | p-Value |
---|---|---|---|---|---|---|
Primary shockable rhythm, n (%) | 91 (37) | 32 (52) | 28 (46) | 19 (31) | 12 (29) *# | 0.007 |
Defibrillation, n (%) | 93 (38.1) | 32 (52) | 28 (46) | 19 (31) | 14 (30) * | 0.003 |
Number of shocks performed in case of defibrillation, n | 1 (1, 1) | (1, 1) | 1 (1, 1) | 1 (1, 2) | 1 (1, 2) | 0.257 |
Number of epinephrine applications, n | 2 (1, 4) | 0 (0, 1) | 1 (0, 3) * | 2 (1, 4) * | 3 (2, 4) *# | 0.001 |
Time to ROSC, median, min | 11 (4, 25) | 4 (1, 10) | 10 (3, 20) * | 15 (6, 30) * | 25 (20, 30) *#° | 0.001 |
Phosphate, median, mmol/L | 1.7 (1.2, 2.5) | 1.2 (0.9, 1.6) | 1.5 (1.2, 2.2) | 1.7 (1.1, 2.3) * | 2.4 (1.8, 3.1) *#° | 0.001 |
TroponinT, median, ng/L | 135 (52, 431) | 69 (37, 207) | 100 (52, 672) | 136 (65, 720) * | 215 (108, 1020) * | 0.001 |
NSE peak, median, µg/L | 45 (30, 88) | 37 (35, 142) | 37 (21, 153) | 39 (33, 293) | 115 (63, 268) *# | 0.003 |
D-Dimere, median, I/U | 8.7 (3.1, 30.0) | 4.0 (1.7, 9.0) | 5.0 (2.6, 16.2) | 11.0 (3.6, 30) * | 20.0 (10.6, 30.0) *# | 0.001 |
pH after ROSC, median | 7.2 (7.1, 7.3) | 7.4 (7.3, 7.4) | 7.3 (7.2, 7.3) * | 7.2 (7.0, 7.3) *# | 7.1 (7.0, 7.2) *# | 0.001 |
PaO2, median, mmHg | 89 (77, 110) | 88 (78, 104) | 87 (77, 107) | 91 (77, 111) | 92 (78, 120) | 0.657 |
Target temperature management, n (%) | 240 (98.4%) | 60 (98.4) | 59 (96.7) | 61 (100) | 60 (98.4) | 1 |
PCI after ROSC, n (%) | 66 (27) | 17 (68) | 19 (31) | 16 (26) | 14 (23) | 0.782 |
ECLS, n (%) | 9 (4) | 3 (5) | 4 (7) | 1 (2) | 1 (2) | 0.374 |
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Haschemi, J.; Müller, C.T.; Haurand, J.M.; Oehler, D.; Spieker, M.; Polzin, A.; Kelm, M.; Horn, P. Lactate to Albumin Ratio for Predicting Clinical Outcomes after In-Hospital Cardiac Arrest. J. Clin. Med. 2023, 12, 4136. https://doi.org/10.3390/jcm12124136
Haschemi J, Müller CT, Haurand JM, Oehler D, Spieker M, Polzin A, Kelm M, Horn P. Lactate to Albumin Ratio for Predicting Clinical Outcomes after In-Hospital Cardiac Arrest. Journal of Clinical Medicine. 2023; 12(12):4136. https://doi.org/10.3390/jcm12124136
Chicago/Turabian StyleHaschemi, Jafer, Charlotte Theresia Müller, Jean Marc Haurand, Daniel Oehler, Maximilian Spieker, Amin Polzin, Malte Kelm, and Patrick Horn. 2023. "Lactate to Albumin Ratio for Predicting Clinical Outcomes after In-Hospital Cardiac Arrest" Journal of Clinical Medicine 12, no. 12: 4136. https://doi.org/10.3390/jcm12124136