External validation of the TiPS65 score for predicting good neurological outcomes in patients with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation
External validation of the TiPS65 score for predicting good neurological outcomes in patients with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation
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DOI：
10.1016/j.resuscitation.2022.11.018
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发表时间：
2022-12-20
期刊：
影响因子：
6.5
通讯作者：
Iwami, Taku
中科院分区：
文献类型：
--
作者：
Makino, Yuto;Okada, Yohei;Iwami, Taku
目的：评估体外心肺复苏（ECPR）患者的预后对于选择候选人至关重要。TiPS 65评分可以预测院外心脏骤停（OHCA）患者接受ECPR治疗的神经结局。我们的目的是对该评分进行外部验证。研究方法：分析了来自日本急性医学协会院外心脏骤停登记处的数据，该登记处是一个多中心、全国性的前瞻性登记数据库。纳入了2018年1月至2019年12月期间接受ECPR治疗的所有OHCA和可电击心律成人患者。在TiPS 65评分中，年龄、呼叫到医院的时间、到达医院时的初始心律和初始pH值被用作预测因素。主要结局是30天生存率和良好的神经功能结局（脑功能分类1或2）。判别，使用C-统计量，和预测性能的每个分数，如灵敏度和特异性，进行了investigated.Results：纳入的590例患者（517 [81.6%]男性;中位数[四分位数范围]年龄，60 [50-69]岁），64（10.8%）报告有利的神经功能的结果。TiPS 65评分的C统计量为0.729（95%置信区间（CI）：0.672-0.786）。当TiPS 65评分的临界值>1时，其敏感性和特异性分别为0.906（95%CI：0.807-0.965）和0.430（95%CI：0.387-0.473）;相反，当临界值设置为>3时，它们分别为0.172结论：TiPS 65评分具有较好的区分力和预测力。该评分可支持在临床环境中选择符合ECPR条件的患者的决策过程。
Aim: Estimating prognosis of patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) is essential for selecting candidates. The TiPS65 score can predict neurological outcomes of patients with out-of-hospital cardiac arrest (OHCA) treated with ECPR. We aimed to perform an external validation of this score. Methods: Data from the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest registry, a multicentred, nationwide, prospectively registered database, were analysed. All adult patients with OHCA and shockable rhythm and treated with ECPR between January 2018 to December 2019 were included. In the TiPS65 score, age, call-to-hospital arrival time, initial cardiac rhythm at hospital arrival, and initial pH value were used as predictors. The primary outcome was 30-day survival with favourable neurological outcomes (Cerebral Performance Category 1 or 2). Discrimina-tion, using the C-statistic, and predictive performances of each score, such as sensitivity and specificity, were investigated.Results: Of 590 included patients (517 [81.6%] men; median [interquartile range] age, 60 [50-69] years), 64 (10.8%) reported favourable neuro-logical outcomes. The C-statistic of the TiPS65 score was 0.729 (95% confidence interval (CI): 0.672-0.786). When the cut-off of TiPS65 score was setto >1, the sensitivity and specificity were 0.906 (95%CI: 0.807-0.965) and 0.430 (95%CI: 0.387-0.473), respectively; conversely, when the cut-off was set to >3, they were 0.172 (95%CI: 0.089-0.287) and 0.971 (95%CI: 0.953-0.984), respectively.Conclusions: The TiPS65 score shows reasonable discrimination and predictive performances. This score can be supportive in the decision-making process for the selection of eligible patients for ECPR in clinical settings.