2017年12月
Initial Blood Ammonia Level Is a Useful Prognostication Tool in Out-of-Hospital Cardiac Arrest - Multicenter Prospective Study (SOS-KANTO 2012 Study)
CIRCULATION JOURNAL
- 巻
- 81
- 号
- 12
- 開始ページ
- 1839
- 終了ページ
- +
- 記述言語
- 英語
- 掲載種別
- DOI
- 10.1253/circj.CJ-17-0335
- 出版者・発行元
- JAPANESE CIRCULATION SOC
Background: Initial blood ammonia level is associated with neurologic outcomes in out-of-hospital cardiac arrest (OHCA). We tested the usefulness of blood ammonia for prediction of long-term neurological outcome of OHCA.Methods and Results: A total of 3,011 hospitalized adult OHCA patients were enrolled. Blood samples were obtained at the ED. Cut-offs (ammonia <100 mu mol/L and lactate <12 mmol/L) were determined in a previous study. Neurological outcomes in survivors were assessed at 3 months. A logistic regression model with adjustment for within-hospital clustering and other risk factors was used to evaluate the association between biomarkers and outcomes. Of 3,011 patients, 380 (13.8%) had favorable neurological outcomes. Ammonia and lactate predicted neurological outcome with an AUC of 0.80 (95% CI: 0.76-0.84) and 0.77 (95% CI: 0.72-0.82), respectively. Adjusted OR for ammonia <100 mu mol/L (4.55; 95% CI: 2.67-7.81) was higher than that for lactate <12 mmol/L (2.63; 95% CI: 1.61-4.28) and most other risk factors, such as cardiac etiology (3.47; 95% CI: 2.55-4.72), age <80 years (3.16; 95% CI: 2.17-4.61), bystander CPR (2.39; 95% CI: 1.70-3.38), and initial rhythm shockable (1.66; 95% CI: 1.16-2.37). The combination of ammonia and lactate had an increased predictive value (AUC, 0.86; 95% CI: 0.85-0.87) compared with that without biomarkers (AUC, 0.81; 95% CI: 0.80-0.82).Conclusions: Initial blood ammonia level is as useful as other traditional prognostic indicators such as lactate. Measurement of both initial blood ammonia and lactate helped accurately predict neurological outcomes after OHCA.
- リンク情報
- ID情報
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- DOI : 10.1253/circj.CJ-17-0335
- ISSN : 1346-9843
- eISSN : 1347-4820
- Web of Science ID : WOS:000416524000016