Hypoxic hepatitis after out-of-hospital cardiac arrest: Incidence, determinants and prognosis
Hypoxic hepatitis after out-of-hospital cardiac arrest: Incidence, determinants and prognosis
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DOI：
10.1016/j.resuscitation.2016.03.021
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发表时间：
2016-06-01
期刊：
影响因子：
6.5
通讯作者：
Cariou, A.
中科院分区：
文献类型：
--
作者：
Champigneulle, B.;Geri, G.;Cariou, A.
目的：低血糖性肝炎（HH）可能会使重症监护室（ICU）中的院外心脏骤停（OHCA）患者复苏过程复杂化。本研究的目的是评估HH的患病率，并描述与HH的发生和outcome.Methods的相关因素：我们进行了为期6年（2009年至2014年）的心脏骤停中心的观察性研究。纳入所有在自主循环恢复（ROSC）后入住ICU且存活超过24小时的非创伤性OHCA患者。HH定义为在OHCA后的前72小时内丙氨酸氨基转移酶升高超过正常上限的20倍。结果：632例OHCA患者中，HH发生率为11.4%（95% CI：9.0%，14.1%），其中12例（11.4%）发生HH。在多变量分析中，从虚脱到ROSC的时间[OR 1.02/分钟; 95% CI（1.00，1.04）; p = 0.01]，男性[OR 0.53; 95% CI（0.29，0.95）; p = 0.03]和初始可电击心律[OR 0.35; 95% CI（0.19，0.65）; p < 0.01]与HH发生相关。调整混杂因素后，HH与ICU死亡率相关[OR 4.39; 95%CI（1.71，11.26）; p < 0.01]，即使在统计模型中考虑了CA后休克的发生，这种相关性仍然存在[OR 3.63; 95%CI（1.39，9.48）; p = 0.01]。结论：HH不是OHCA后的罕见并发症。该并发症主要由复苏持续时间引发，并与ICU死亡率增加相关。(C)2016爱思唯尔爱尔兰有限公司版权所有。
Aim: Hypoxic hepatitis (HH) may complicate the course of resuscitated out-of-hospital cardiac arrest (OHCA) patients admitted in intensive care unit (ICU). Aims of this study were to assess the prevalence of HH, and to describe the factors associated with HH occurrence and outcome.Methods: We conducted an observational study over a 6-year period (2009-2014) in a cardiac arrest center. All non-traumatic OHCA patients admitted in the ICU after return of spontaneous circulation (ROSC) and who survived more than 24 h were included. HH was defined as an elevation of alanine aminotransferase over 20 times the upper limit of normal during the first 72 h after OHCA. Factors associated with HH and ICU mortality were picked up by multivariate logistic regression.Results: Among the 632 OHCA patients included in the study, HH was observed in 72 patients (11.4% (95% CI: 9.0%, 14.1%)). In multivariate analysis, time from collapse to ROSC [OR 1.02 per additional minute; 95% CI (1.00, 1.04); p = 0.01], male gender [OR 0.53; 95% CI (0.29, 0.95); p = 0.03] and initial shockable rhythm [OR 0.35; 95% CI (0.19, 0.65); p < 0.01] were associated with HH occurrence. After adjustment for confounding factors, HH was associated with ICU mortality [OR 4.39; 95% CI (1.71, 11.26); p < 0.01] and this association persisted even if occurrence of a post-CA shock was considered in the statistical model [OR 3.63; 95% CI (1.39, 9.48); p = 0.01].Conclusions: HH is not a rare complication after OHCA. This complication is mainly triggered by the duration of resuscitation and is associated with increased ICU mortality. (C) 2016 Elsevier Ireland Ltd. All rights reserved.