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Blood laboratory analyses preceding in-hospital cardiac arrest: A matched case-control study
Peter C Lind1,2, Nikola Stankovic1,2,3, Mathias J Holmberg1,2
1Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Insights
Patients experiencing in-hospital cardiac arrest (IHCA) had more frequent blood tests before the event. Higher lactate levels were observed in IHCA patients compared to matched controls.
Area of Science:
- Clinical Medicine
- Biochemistry
- Critical Care Medicine
Background:
- Investigating differences in blood laboratory analyses between patients who experience in-hospital cardiac arrest (IHCA) and other hospitalized patients.
- Understanding pre-arrest physiological markers is crucial for predicting and potentially preventing IHCA.
Purpose of the Study:
- To compare the frequency, results, and trends of blood laboratory analyses in patients with IHCA versus matched controls.
- To identify specific laboratory markers that may indicate an increased risk of IHCA.
Main Methods:
- Matched case-control study utilizing Danish national registries from 2017 to 2021.
- Included 9268 IHCA cases and 92,395 matched controls, comparing 51 blood laboratory analyses.
- Focused on lactate, sodium, potassium, and hemoglobin, analyzing samples within 24 hours prior to the index time.
Main Results:
- IHCA cases showed significantly higher sampling frequencies for all tested analytes compared to controls.
- Lactate levels were notably higher in IHCA cases (median [IQR]: 2.3 [1.3, 4.9]) versus controls (median [IQR]: 1.3 [0.9, 2.0]).
- Elevated lactate and potassium levels increased as the time to cardiac arrest decreased in cases, but not controls.
Conclusions:
- Patients with IHCA undergo more frequent blood sampling before the event.
- Higher pre-arrest lactate levels are a key differentiator in patients who experience IHCA.
- Findings highlight the potential utility of monitoring lactate trends for IHCA risk assessment.
Background:
Whether blood laboratory analyses differ in patients who later suffer in-hospital cardiac arrest (IHCA) compared to other hospitalised patients remains unknown. The aim of this study was to describe pre-arrest sampling frequencies, results, and trends in blood laboratory analyses in patients with IHCA compared to controls.
Methods:
This study was a matched case-control study using national registries in Denmark. Cases were defined as patients with IHCA from 2017 to 2021. Controls were defined as hospitalised patients and were matched on age, sex, and date and length of admission. Data on a total of 51 different blood laboratory analyses were obtained. The laboratory analyses of primary interest were lactate, sodium, potassium, and haemoglobin. The index time for cases was defined as the time of cardiac arrest, and a corresponding index time was defined for controls based on the time to cardiac arrest for their corresponding case. Blood sampling frequencies were reported for blood laboratory analyses obtained either within the last 24 h before the index time or between the time of hospital admission and the index time. Blood sampling results were reported for blood laboratory analyses obtained within the last 24 h before the index time.
Results:
A total of 9268 cases and 92,395 controls were included in this study. Cases underwent more frequent sampling of all blood laboratory analyses compared to controls. This higher sampling frequency was more pronounced for lactate compared to sodium, potassium, or haemoglobin. The last measured lactate was higher in cases (median [IQR]: 2.3 [1.3, 4.9]) compared to controls (median [IQR]: 1.3 [0.9, 2.0]). Differences in sodium, potassium, and haemoglobin were negligible. The proportion of abnormally elevated levels of lactate and potassium increased as time to cardiac arrest decreased; no such effect was seen in controls. No temporal trend was evident for sodium or haemoglobin.
Conclusions:
Patients with IHCA undergo more frequent blood sampling prior to IHCA and have higher levels of lactate compared to matched controls.
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