BACKGROUND In-hospital cardiac arrest(IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied a...BACKGROUND In-hospital cardiac arrest(IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation(ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio(NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.AIM To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.METHODS A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value(NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis(area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.RESULTS We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female.In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9(range 0.6-46.5) compared with 8.9(0.28-96) in non-survivors(P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55[odds ratio(OR) = 5.20, confidence interval(CI): 1.5-18.3, P = 0.01], older age(OR= 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level(OR = 1.20, CI:1.03-1.40, P = 0.02) were independent predictors of death.CONCLUSION An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.展开更多
2018年美国心脏病协会(The American Heart Association,AHA)和国际复苏联络委员会(International Liaison Committee on Resuscitation,ILCOR)更新了心肺复苏指南,推荐对胺碘酮和利多卡因治疗电除颤难复律性心室颤动(ventricular fibri...2018年美国心脏病协会(The American Heart Association,AHA)和国际复苏联络委员会(International Liaison Committee on Resuscitation,ILCOR)更新了心肺复苏指南,推荐对胺碘酮和利多卡因治疗电除颤难复律性心室颤动(ventricular fibrillation,VF)或无脉性室性心动过速(pulseless ventricular tachycardia,pVT)。本文总结胺碘酮、利多卡因在心肺复苏中的药理作用及推荐剂量,回顾两者在心肺复苏中的研究进展。展开更多
文摘BACKGROUND In-hospital cardiac arrest(IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation(ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio(NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.AIM To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.METHODS A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value(NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis(area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.RESULTS We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female.In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9(range 0.6-46.5) compared with 8.9(0.28-96) in non-survivors(P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55[odds ratio(OR) = 5.20, confidence interval(CI): 1.5-18.3, P = 0.01], older age(OR= 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level(OR = 1.20, CI:1.03-1.40, P = 0.02) were independent predictors of death.CONCLUSION An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.
