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Cardiac Arrest-Associated Coagulopathy Could Predict 30-day Mortality: A Retrospective Study from Medical Information
Jingwei Duan1, Hongxia Ge1, Wenyang Fan1
1Emergency Department, Peking University Third Hospital, Beijing, China.
Insights
Cardiac arrest-associated coagulopathy (CAAC) significantly increases mortality risk. Severity of CAAC correlates with increased mortality, highlighting its prognostic value for cardiac arrest patients.
Area of Science:
- Critical Care Medicine
- Hematology
- Cardiology
Background:
- Cardiac arrest (CA) can activate the coagulation system, leading to cardiac arrest-associated coagulopathy (CAAC).
- Early identification of CAAC is crucial for predicting outcomes and preventing complications like disseminated intravascular coagulation.
Purpose of the Study:
- To determine if CAAC is a predictor of 30-day cumulative mortality in cardiac arrest patients.
Main Methods:
- Retrospective cohort study using the MIMIC-IV database (2008-2019).
- CAAC diagnosed based on international normalized ratio (INR) and platelet count, stratified into mild, moderate, and severe.
- Severity criteria: Mild (1.2≤INR<1.4, 100k
Main Results:
- 1485 patients included; CAAC patients had higher mortality (52.0% vs 33.0%, P<0.001).
- Increased CAAC severity correlated with higher mortality risk.
- Adjusted analysis confirmed CAAC independently associated with 30-day mortality (HR 1.77, P<0.001), with moderate (HR 1.48, P=0.027) and severe (HR 2.22, P<0.001) CAAC showing significant associations.
Conclusions:
- CAAC identifies cardiac arrest patients at higher risk of mortality.
- Mortality risk increases incrementally with CAAC severity.
- Further validation via multicenter studies is recommended.
Background:
Cardiac arrest (CA) can activate the coagulation system. Some coagulation-related indicators are associated with clinical outcomes. Early evaluation of patients with cardiac arrest-associated coagulopathy (CAAC) not only predicts clinical outcomes, but also allows for timely clinical intervention to prevent disseminated intravascular coagulation.
Objective:
To assess whether CAAC predicts 30-day cumulative mortality.
Methods:
From the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, we conducted a retrospective cohort study from 2008 to 2019. Based on international normalized ratio (INR) value and platelet count, we diagnosed CAAC cases and made the following stratification of severity: mild CAAC was defined as 1.4 > INR≧1.2 and 100,000/µL < platelet count≦150,000/µL; moderate CAAC was defined with either 1.6 > INR≧1.4 or 80,000/µL < platelet count≦100,000/µL; severe CAAC was defined as an INR≧1.6 and platelet count≦80,000/µL.
Results:
A total of 1485 patients were included. Crude survival analysis showed that patients with CAAC had higher mortality risk than those without CAAC (33.0% vs 52.0%, P < 0.001). Unadjusted survival analysis showed an incremental increase in the risk of mortality as the severity of CAAC increased. After adjusting confounders (prehospital characteristics and hospitalization characteristics), CAAC was independently associated with 30-day mortality (hazard rate [HR] 1.77, 95% confidence interval [CI] 1.41-2.25; P < 0.001); moderate CAAC (HR 1.48, 95% CI 1.09-2.10; P = 0.027) and severe CAAC (HR 2.22, 95% CI 1.64-2.97; P < 0.001) were independently associated with 30-day mortality.
Conclusion:
The presence of CAAC identifies a group of CA at higher risk for mortality, and there is an incremental increase in risk of mortality as the severity of CAAC increases. However, the results of this study should be further verified by multicenter study.
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