Routine blood markers from different biological pathways improve early risk stratification in cardiac arrest patients: Results from the prospective, observational COMMUNICATE study
Prognostication of cardiac arrest patients admitted to the intensive care unit (ICU) may influence treatment decision, but remains challenging. We evaluated the incremental usefulness of routine blood markers from different biological pathways for predicting fatal outcome and neurological deficits i...
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| Veröffentlicht in: | Resuscitation 2018-09, Vol.130, p.138-145 |
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| creator | Isenschmid, Cyril Kalt, Jeanice Gamp, Martina Tondorf, Theresa Becker, Christoph Tisljar, Kai Locher, Stefan Schuetz, Philipp Marsch, Stephan Hunziker, Sabina |
| description | Prognostication of cardiac arrest patients admitted to the intensive care unit (ICU) may influence treatment decision, but remains challenging. We evaluated the incremental usefulness of routine blood markers from different biological pathways for predicting fatal outcome and neurological deficits in cardiac arrest patients.
We prospectively included consecutive, adult cardiac arrest patients upon ICU admission. We recorded initial clinical parameters and measured blood markers of cardiac injury/stress (troponin, BNP, CK), inflammation/infection (WBC, CRP, procalcitonin) and shock (lactate, creatinine, urea). The primary and secondary endpoints were all-cause in-hospital mortality and bad neurological outcome defined by the Cerebral Performance Category (CPC) score.
Mortality in the 321 included patients was 49% (n = 156). Procalcitonin (adjusted odds ratio 1.84, 95%CI 1.34 to 2.53, p |
| doi_str_mv | 10.1016/j.resuscitation.2018.07.021 |
| format | Article |
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We prospectively included consecutive, adult cardiac arrest patients upon ICU admission. We recorded initial clinical parameters and measured blood markers of cardiac injury/stress (troponin, BNP, CK), inflammation/infection (WBC, CRP, procalcitonin) and shock (lactate, creatinine, urea). The primary and secondary endpoints were all-cause in-hospital mortality and bad neurological outcome defined by the Cerebral Performance Category (CPC) score.
Mortality in the 321 included patients was 49% (n = 156). Procalcitonin (adjusted odds ratio 1.84, 95%CI 1.34 to 2.53, p < 0.001; AUC 0.73) and lactate (adjusted odds ratio 7.29, 95%CI 3.05 to 17.42, p < 0.001; AUC 0.70) were identified as independent prognostic factors for mortality and significantly improved discrimination of a parsimonious clinical model including resuscitation measures (no-flow time, shockable rhythm) and initial vital signs (Glasgow coma scale, respiratory rate) from an AUC of 0.79 to 0.84 (p < 0.001). Cardiac markers did not further improve the model. Results for neurological outcome were similar with model improvements by procalcitonin and lactate from AUC 0.83 to 0.87 (p = 0.004).
Assessment of routine markers of inflammation/infection and shock provide significant improvements for prognostication of cardiac arrest patients, while cardiac markers did not further improve statistical models. Combination of blood markers and clinical parameters may help to improve initial management decisions in this vulnerable patient population.</description><identifier>ISSN: 0300-9572</identifier><identifier>EISSN: 1873-1570</identifier><identifier>DOI: 10.1016/j.resuscitation.2018.07.021</identifier><identifier>PMID: 30036589</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Aged ; Biomarker ; Biomarkers - blood ; Cardiac arrest ; Cardiopulmonary resuscitation ; Cardiopulmonary Resuscitation - adverse effects ; Cardiopulmonary Resuscitation - methods ; Early Diagnosis ; Female ; Hospital Mortality ; Humans ; Inflammation - blood ; Intensive Care Units - statistics & numerical data ; Male ; Middle Aged ; Nervous System Diseases - diagnosis ; Nervous System Diseases - etiology ; Neurological outcome ; Out-of-Hospital Cardiac Arrest - blood ; Out-of-Hospital Cardiac Arrest - diagnosis ; Out-of-Hospital Cardiac Arrest - mortality ; Out-of-Hospital Cardiac Arrest - therapy ; Predictive value ; Predictive Value of Tests ; Prognosis ; Risk Assessment - methods ; Risk stratification ; Shock - blood ; Switzerland - epidemiology</subject><ispartof>Resuscitation, 2018-09, Vol.130, p.138-145</ispartof><rights>2018 Elsevier B.V.</rights><rights>Copyright © 2018 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c383t-837ed73b81e27be47c503a5634a37f6a4f0de8b8d3e7115324165b5eab657bb93</citedby><cites>FETCH-LOGICAL-c383t-837ed73b81e27be47c503a5634a37f6a4f0de8b8d3e7115324165b5eab657bb93</cites><orcidid>0000-0001-6039-4003 ; 0000-0001-6400-4949 ; 0000-0002-4095-2765</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.resuscitation.2018.07.021$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30036589$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Isenschmid, Cyril</creatorcontrib><creatorcontrib>Kalt, Jeanice</creatorcontrib><creatorcontrib>Gamp, Martina</creatorcontrib><creatorcontrib>Tondorf, Theresa</creatorcontrib><creatorcontrib>Becker, Christoph</creatorcontrib><creatorcontrib>Tisljar, Kai</creatorcontrib><creatorcontrib>Locher, Stefan</creatorcontrib><creatorcontrib>Schuetz, Philipp</creatorcontrib><creatorcontrib>Marsch, Stephan</creatorcontrib><creatorcontrib>Hunziker, Sabina</creatorcontrib><title>Routine blood markers from different biological pathways improve early risk stratification in cardiac arrest patients: Results from the prospective, observational COMMUNICATE study</title><title>Resuscitation</title><addtitle>Resuscitation</addtitle><description>Prognostication of cardiac arrest patients admitted to the intensive care unit (ICU) may influence treatment decision, but remains challenging. We evaluated the incremental usefulness of routine blood markers from different biological pathways for predicting fatal outcome and neurological deficits in cardiac arrest patients.
We prospectively included consecutive, adult cardiac arrest patients upon ICU admission. We recorded initial clinical parameters and measured blood markers of cardiac injury/stress (troponin, BNP, CK), inflammation/infection (WBC, CRP, procalcitonin) and shock (lactate, creatinine, urea). The primary and secondary endpoints were all-cause in-hospital mortality and bad neurological outcome defined by the Cerebral Performance Category (CPC) score.
Mortality in the 321 included patients was 49% (n = 156). Procalcitonin (adjusted odds ratio 1.84, 95%CI 1.34 to 2.53, p < 0.001; AUC 0.73) and lactate (adjusted odds ratio 7.29, 95%CI 3.05 to 17.42, p < 0.001; AUC 0.70) were identified as independent prognostic factors for mortality and significantly improved discrimination of a parsimonious clinical model including resuscitation measures (no-flow time, shockable rhythm) and initial vital signs (Glasgow coma scale, respiratory rate) from an AUC of 0.79 to 0.84 (p < 0.001). Cardiac markers did not further improve the model. Results for neurological outcome were similar with model improvements by procalcitonin and lactate from AUC 0.83 to 0.87 (p = 0.004).
Assessment of routine markers of inflammation/infection and shock provide significant improvements for prognostication of cardiac arrest patients, while cardiac markers did not further improve statistical models. Combination of blood markers and clinical parameters may help to improve initial management decisions in this vulnerable patient population.</description><subject>Aged</subject><subject>Biomarker</subject><subject>Biomarkers - blood</subject><subject>Cardiac arrest</subject><subject>Cardiopulmonary resuscitation</subject><subject>Cardiopulmonary Resuscitation - adverse effects</subject><subject>Cardiopulmonary Resuscitation - methods</subject><subject>Early Diagnosis</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Inflammation - blood</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nervous System Diseases - diagnosis</subject><subject>Nervous System Diseases - etiology</subject><subject>Neurological outcome</subject><subject>Out-of-Hospital Cardiac Arrest - blood</subject><subject>Out-of-Hospital Cardiac Arrest - diagnosis</subject><subject>Out-of-Hospital Cardiac Arrest - mortality</subject><subject>Out-of-Hospital Cardiac Arrest - therapy</subject><subject>Predictive value</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Risk Assessment - methods</subject><subject>Risk stratification</subject><subject>Shock - blood</subject><subject>Switzerland - epidemiology</subject><issn>0300-9572</issn><issn>1873-1570</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUd1u0zAUthCIdYNXQJa44YIEO47jFK5Q1QHSxqRpu7Zs54S5S-JiO0V9Lx6QU1qQuOPKkvX9no-Q15yVnPHm3aaMkObkfDbZh6msGG9LpkpW8SdkwVslCi4Ve0oWTDBWLKWqzsh5ShvGmJBL9Zyc4b9oZLtckJ-3Yc5-AmqHEDo6mvgIMdE-hpF2vu8hwpSp9WEI37wzA92a_PDD7BP14zaGHVAwcdjT6NMjTTlipB5xh2DUT9SZ2HnjqImYOR_IHvXSe3qLFYZ8MsoPQFEsbcFlv4O3NNgEcfdbBS1XN9fX91-_rD7erdFi7vYvyLPeDAlent4Lcn-5vlt9Lq5uPiHsqnCiFblohYJOCdtyqJSFWjnJhJGNqI1QfWPqnnXQ2rYToDiXoqp5I60EYxuprF2KC_LmqIvhvs9YQI8-ORgGM0GYk66YkrJu5LJG6Icj1GGPFKHX2-jxmnvNmT7Mpjf6n9n0YTbNlMbZkP3qZDTbEbq_3D87IWB9BADW3XmIGoVgctD5iEfTXfD_ZfQLsAu2cQ</recordid><startdate>201809</startdate><enddate>201809</enddate><creator>Isenschmid, Cyril</creator><creator>Kalt, Jeanice</creator><creator>Gamp, Martina</creator><creator>Tondorf, Theresa</creator><creator>Becker, Christoph</creator><creator>Tisljar, Kai</creator><creator>Locher, Stefan</creator><creator>Schuetz, Philipp</creator><creator>Marsch, Stephan</creator><creator>Hunziker, Sabina</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6039-4003</orcidid><orcidid>https://orcid.org/0000-0001-6400-4949</orcidid><orcidid>https://orcid.org/0000-0002-4095-2765</orcidid></search><sort><creationdate>201809</creationdate><title>Routine blood markers from different biological pathways improve early risk stratification in cardiac arrest patients: Results from the prospective, observational COMMUNICATE study</title><author>Isenschmid, Cyril ; Kalt, Jeanice ; Gamp, Martina ; Tondorf, Theresa ; Becker, Christoph ; Tisljar, Kai ; Locher, Stefan ; Schuetz, Philipp ; Marsch, Stephan ; Hunziker, Sabina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c383t-837ed73b81e27be47c503a5634a37f6a4f0de8b8d3e7115324165b5eab657bb93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Biomarker</topic><topic>Biomarkers - blood</topic><topic>Cardiac arrest</topic><topic>Cardiopulmonary resuscitation</topic><topic>Cardiopulmonary Resuscitation - adverse effects</topic><topic>Cardiopulmonary Resuscitation - methods</topic><topic>Early Diagnosis</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Inflammation - blood</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nervous System Diseases - diagnosis</topic><topic>Nervous System Diseases - etiology</topic><topic>Neurological outcome</topic><topic>Out-of-Hospital Cardiac Arrest - blood</topic><topic>Out-of-Hospital Cardiac Arrest - diagnosis</topic><topic>Out-of-Hospital Cardiac Arrest - mortality</topic><topic>Out-of-Hospital Cardiac Arrest - therapy</topic><topic>Predictive value</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Risk Assessment - methods</topic><topic>Risk stratification</topic><topic>Shock - blood</topic><topic>Switzerland - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Isenschmid, Cyril</creatorcontrib><creatorcontrib>Kalt, Jeanice</creatorcontrib><creatorcontrib>Gamp, Martina</creatorcontrib><creatorcontrib>Tondorf, Theresa</creatorcontrib><creatorcontrib>Becker, Christoph</creatorcontrib><creatorcontrib>Tisljar, Kai</creatorcontrib><creatorcontrib>Locher, Stefan</creatorcontrib><creatorcontrib>Schuetz, Philipp</creatorcontrib><creatorcontrib>Marsch, Stephan</creatorcontrib><creatorcontrib>Hunziker, Sabina</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Resuscitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Isenschmid, Cyril</au><au>Kalt, Jeanice</au><au>Gamp, Martina</au><au>Tondorf, Theresa</au><au>Becker, Christoph</au><au>Tisljar, Kai</au><au>Locher, Stefan</au><au>Schuetz, Philipp</au><au>Marsch, Stephan</au><au>Hunziker, Sabina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Routine blood markers from different biological pathways improve early risk stratification in cardiac arrest patients: Results from the prospective, observational COMMUNICATE study</atitle><jtitle>Resuscitation</jtitle><addtitle>Resuscitation</addtitle><date>2018-09</date><risdate>2018</risdate><volume>130</volume><spage>138</spage><epage>145</epage><pages>138-145</pages><issn>0300-9572</issn><eissn>1873-1570</eissn><abstract>Prognostication of cardiac arrest patients admitted to the intensive care unit (ICU) may influence treatment decision, but remains challenging. We evaluated the incremental usefulness of routine blood markers from different biological pathways for predicting fatal outcome and neurological deficits in cardiac arrest patients.
We prospectively included consecutive, adult cardiac arrest patients upon ICU admission. We recorded initial clinical parameters and measured blood markers of cardiac injury/stress (troponin, BNP, CK), inflammation/infection (WBC, CRP, procalcitonin) and shock (lactate, creatinine, urea). The primary and secondary endpoints were all-cause in-hospital mortality and bad neurological outcome defined by the Cerebral Performance Category (CPC) score.
Mortality in the 321 included patients was 49% (n = 156). Procalcitonin (adjusted odds ratio 1.84, 95%CI 1.34 to 2.53, p < 0.001; AUC 0.73) and lactate (adjusted odds ratio 7.29, 95%CI 3.05 to 17.42, p < 0.001; AUC 0.70) were identified as independent prognostic factors for mortality and significantly improved discrimination of a parsimonious clinical model including resuscitation measures (no-flow time, shockable rhythm) and initial vital signs (Glasgow coma scale, respiratory rate) from an AUC of 0.79 to 0.84 (p < 0.001). Cardiac markers did not further improve the model. Results for neurological outcome were similar with model improvements by procalcitonin and lactate from AUC 0.83 to 0.87 (p = 0.004).
Assessment of routine markers of inflammation/infection and shock provide significant improvements for prognostication of cardiac arrest patients, while cardiac markers did not further improve statistical models. Combination of blood markers and clinical parameters may help to improve initial management decisions in this vulnerable patient population.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>30036589</pmid><doi>10.1016/j.resuscitation.2018.07.021</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-6039-4003</orcidid><orcidid>https://orcid.org/0000-0001-6400-4949</orcidid><orcidid>https://orcid.org/0000-0002-4095-2765</orcidid></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Aged Biomarker Biomarkers - blood Cardiac arrest Cardiopulmonary resuscitation Cardiopulmonary Resuscitation - adverse effects Cardiopulmonary Resuscitation - methods Early Diagnosis Female Hospital Mortality Humans Inflammation - blood Intensive Care Units - statistics & numerical data Male Middle Aged Nervous System Diseases - diagnosis Nervous System Diseases - etiology Neurological outcome Out-of-Hospital Cardiac Arrest - blood Out-of-Hospital Cardiac Arrest - diagnosis Out-of-Hospital Cardiac Arrest - mortality Out-of-Hospital Cardiac Arrest - therapy Predictive value Predictive Value of Tests Prognosis Risk Assessment - methods Risk stratification Shock - blood Switzerland - epidemiology |
| title | Routine blood markers from different biological pathways improve early risk stratification in cardiac arrest patients: Results from the prospective, observational COMMUNICATE study |
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