Prognostic impact of serum albumin concentration for neurologically favorable outcome in patients treated with target temperature management after out-of-hospital cardiac arrest: a multicenter prospective study
Prognostic impact of serum albumin concentration for neurologically favorable outcome in patients treated with target temperature management after out-of-hospital cardiac arrest: a multicenter prospective study
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血清白蛋白浓度对院外心脏骤停后接受目标温度管理的患者神经学良好结局的预后影响：一项多中心前瞻性研究
DOI：
10.1089/ther.2017.0053
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发表时间：
2018
影响因子：
1.2
通讯作者：
Shimazu T,
中科院分区：
文献类型：
--
作者：
Matsuyama T;Iwami T;Yamada T;Hayakawa K;Yoshiya K;Irisawa T;Abe Y;Nishimura T;Uejima T;Ohishi Y;Kiguchi T;Kishi M;Kishimoto M;Nakao S;Hayashi Y;Sogabe T;Morooka T;Izawa J;Shimamoto T;Hatakeyama T;Fujii T;Sado J;Kawamura T;Shimazu T,
评估入院时测量的血清白蛋白浓度是否可作为接受目标温度管理（TTM）治疗的院外心脏骤停（OHCA）患者神经学有利结局的早期预后生物标志物。这项前瞻性、多中心观察性研究（CRITICAL研究）于2012年7月1日至2014年12月31日在日本大坂府进行，涉及13家重症医学中心（CCMC）和1家非CCMC急诊科。本研究纳入了接受OHCA的≥18岁患者，急救医疗服务人员尝试对其进行复苏，然后将其运送至参与机构，然后接受TTM治疗。根据入院时的血清白蛋白浓度，将患者分为四个四分位数（Q1-Q4），定义为Q1（<3.0 g/dL）、Q2（≥3.0，<3.4 g/dL）、Q3（≥3.4，<3.8 g/dL）和Q4（≥3.8 g/dL）。本研究的主要结局是1个月生存率，神经功能良好的结局定义为脑功能分类1或2。在研究期间，共有327人符合我们的分析条件。神经系统良好结局的总体比例为33.0%（108/327）。Q4组的神经学有利结局比例最高（52.5% [48/91]），其次是Q3（34.5% [30/87]）、Q2（27.3% [21/77]）和Q1（12.5% [9/72]）。多因素Logistic回归分析显示，Q4组神经学良好结局的比例显著高于Q1组（校正比值比10.39; 95%置信区间3.36-32.17）。神经功能良好结局的校正比例在增加的四分位数中以逐步方式增加（p< 0.001）。在这项研究中，到达医院时较高的血清白蛋白浓度与OHCA后神经学良好结局呈正相关，呈剂量依赖性。
To assess whether serum albumin concentration measured upon hospital arrival was useful as an early prognostic biomarker for neurologically favorable outcome in out-of-hospital cardiac arrest (OHCA) patients treated with target temperature management (TTM). This prospective, multicenter observational study (The CRITICAL Study) carried out between July 1, 2012 and December 31, 2014 in Osaka Prefecture, Japan involving 13 critical care medical centers (CCMCs) and one non-CCMC with an emergency department. This study included patients ≥18 years of age who underwent an OHCA, for whom resuscitation was attempted by Emergency Medical Services personnel and were then transported to participating institutions, and who were then treated with TTM. Based on the serum albumin concentration upon hospital arrival, involved patients were divided into four quartiles (Q1–Q4) defined as Q1 (<3.0 g/dL), Q2 (≥3.0, <3.4 g/dL), Q3 (≥3.4, <3.8 g/dL), and Q4 (≥3.8 g/dL). The primary outcome of this study was 1-month survival with neurologically favorable outcome defined by cerebral performance category 1 or 2. During the study period, a total of 327 were eligible for our analysis. The overall proportion of neurologically favorable outcome was 33.0% (108/327). The Q4 group had the highest proportion of neurologically favorable outcome (52.5% [48/91]), followed by Q3 (34.5% [30/87]), Q2 (27.3% [21/77]), and Q1 (12.5% [9/72]). The multivariable logistic regression analysis demonstrated that the proportion of neurologically favorable outcome was significantly higher in the Q4 group than that in the Q1 group (adjusted odds ratio 10.39; 95% confidence interval 3.36–32.17). The adjusted proportion of neurologically favorable outcome increased in a stepwise fashion across increasing quartiles (p< 0.001). In this study, higher serum albumin concentration upon hospital arrival had a positive association with neurologically favorable outcome after OHCA in a dose-dependent manner.