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Prognostic implication of initial coagulopathy in out-of-hospital cardiac arrest

Joonghee Kim1, Kyuseok Kim, Jae Hyuk Lee

  • 1Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.

Resuscitation
|September 15, 2012
PubMed

Insights

An elevated initial Disseminated Intravascular Coagulation (DIC) score in out-of-hospital cardiac arrest (OHCA) patients independently predicts worse outcomes. This score is a crucial early indicator of increased mortality risk and poor long-term prognosis after cardiac arrest.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Hematology

Background:

  • Early coagulopathy is a critical factor in outcomes following out-of-hospital cardiac arrest (OHCA).
  • The initial Disseminated Intravascular Coagulation (DIC) score may represent early coagulopathy and hold prognostic value.

Purpose of the Study:

  • To investigate the prognostic significance of the initial DIC score in OHCA patients.
  • To determine if early coagulopathy, as indicated by the DIC score, predicts patient outcomes.

Main Methods:

  • Analysis of an OHCA registry (2008-2011) for patients with Return of Spontaneous Circulation (ROSC) and no recent anticoagulant use.
  • Assessment of prehospital factors, initial laboratory results, and therapeutic hypothermia.
  • Logistic regression and Cox proportional hazards models used to analyze outcomes including survival discharge, 6-month Cerebral Performance Category (CPC), and survival duration.

Main Results:

  • Higher initial DIC scores were significantly associated with increased in-hospital death (adjusted OR 1.61) and unfavorable long-term outcomes (adjusted OR 1.84).
  • A graded increase in mortality risk was observed with higher DIC score categories (adjusted HRs ranging from 1.96 to 4.29 compared to DIC score <3).
  • The DIC score demonstrated good predictive ability for unfavorable long-term outcomes (AUC 0.79).

Conclusions:

  • The initial DIC score is an independent predictor of poor outcomes in OHCA patients.
  • Elevated initial DIC scores signify increased early mortality risk and unfavorable long-term prognosis.
Abstract

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