Dong Hun Lee1, Byung Kook Lee2, Kyung Woon Jeung1, Yong Hun Jung1, Sung Min Lee1, Yong Soo Cho1, Seong-Woo Yun3, Yong Il Min1. 1. Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea. 2. Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea. Electronic address: bbukkuk@hanmail.net. 3. Department of Emergency Medical Technology, Namseoul University, 91 Daehak-ro, Seonghwan-eup, Seobuk-gu, Cheonan, Chungnam, Republic of Korea.
Abstract
PURPOSE: We aimed to examine the serial changes in coagulofibrinolytic markers that occurred after the restoration of spontaneous circulation (ROSC) in cardiac arrest patients, who were treated with targeted temperature management (TTM). We also evaluated the association between the disseminated intravascular coagulation (DIC) score and clinical outcomes. METHODS: This was a single-centre, retrospective observational study that included cardiac arrest patients who were treated with TTM from May 2012 to December 2015. The prothrombin time (PT) and partial thromboplastin time (PTT), along with the levels of fibrinogen, fibrin degradation products (FDP), and D-dimer were obtained after ROSC and on day 1, 2, and 3. The DIC score was calculated after ROSC. The primary outcome was the neurologic outcome at discharge and the secondary outcome was the 6-month mortality. RESULTS: This study included 317 patients. Of these, 222 (70.0%) and 194 (61.2%) patients had a poor neurologic outcome at discharge and 6-month mortality, respectively. The PT, PTT, and fibrinogen level significantly increased over time, while the FDP and D-dimer levels decreased during first three days after ROSC. Multivariate logistic analyses revealed that the DIC score remained a significant predictor for poor neurologic outcome (odds ratio [OR], 1.800; 95% confidence interval [CI], 1.323-2.451) and 6-month mortality (OR, 1.773; 95% CI, 1.307-2.405). CONCLUSION: The activity of coagulation and fibrinolysis decreased over time. An increased DIC score was an independent prognostic factor for poor neurologic outcome and 6-month mortality.
PURPOSE: We aimed to examine the serial changes in coagulofibrinolytic markers that occurred after the restoration of spontaneous circulation (ROSC) in cardiac arrestpatients, who were treated with targeted temperature management (TTM). We also evaluated the association between the disseminated intravascular coagulation (DIC) score and clinical outcomes. METHODS: This was a single-centre, retrospective observational study that included cardiac arrestpatients who were treated with TTM from May 2012 to December 2015. The prothrombin time (PT) and partial thromboplastin time (PTT), along with the levels of fibrinogen, fibrin degradation products (FDP), and D-dimer were obtained after ROSC and on day 1, 2, and 3. The DIC score was calculated after ROSC. The primary outcome was the neurologic outcome at discharge and the secondary outcome was the 6-month mortality. RESULTS: This study included 317 patients. Of these, 222 (70.0%) and 194 (61.2%) patients had a poor neurologic outcome at discharge and 6-month mortality, respectively. The PT, PTT, and fibrinogen level significantly increased over time, while the FDP and D-dimer levels decreased during first three days after ROSC. Multivariate logistic analyses revealed that the DIC score remained a significant predictor for poor neurologic outcome (odds ratio [OR], 1.800; 95% confidence interval [CI], 1.323-2.451) and 6-month mortality (OR, 1.773; 95% CI, 1.307-2.405). CONCLUSION: The activity of coagulation and fibrinolysis decreased over time. An increased DIC score was an independent prognostic factor for poor neurologic outcome and 6-month mortality.
Authors: Nguyen Mai; Sara A Knowlden; Kathleen Miller-Rhodes; Viollandi Prifti; Max Sims; Mark Grier; Mark Nelson; Marc W Halterman Journal: Exp Mol Pathol Date: 2020-12-29 Impact factor: 4.401