Article révisé par les pairs
Résumé : Introduction: Early prognostication of neurological outcome after cardiopulmonary resuscitation (CPR) is extremely important as it can help to reassess therapeutic intensity or select high-risk patients for specific interventionsHypothesis: Age and biological variables obtained from initial simple blood tests could predict poor neurological outcome (PNO) after CPRMethods: Data from all patients admitted after CPR (in and out-of-hospital) from January 2008 to December 2011 in a mixed 35-bed ICU were assessed. Therapeutic hypothermia was used in all patients. We identified those who had a complete blood gas/electrolyte panel within the first hour after ICU admission. PNO was defined as a cerebral performance category (CPC) score of 4-5 at hospital discharge. We calculated areas under the receiver operating characteristic curve (AUROC) for each variable and derived the score from those having the highest AUROCs. We identified the best cut-off point (the best combination of sensitivity and specificity) which was used as a dichotomic value (0 or 1), with 1 representing PNO. We constructed 20 different models with combinations of the variables to identify the best model according to the highest AUROC. All analyses were performed with SPSS 19.0Results: A total of 127 patients (mean age 61 years, male gender 76%) were included in the analysis; 69% had out-of-hospital CPR and 57% had shockable rhythms. Overall mortality was 58%. Individual AUROCs (CI 95%) used in the model were: Hemoglobin (Hb) 0.65 (0.55-0.74), blood glucose (Gly) 0.63 (0.53-0.73), lactate (Lac) 0.62 (0.52-0.72), total CO2 (TCO2) 0.59 (0.49-0.69), and age 0.62 (0.52-0.71). The model with the best AUROC (0.772 (0.69-0.85)) included Hb < 12.5 g/dl, Gly > 180 mg/dl, Lac > 2 mEq/L, TCO2 < 20 mEq/L and age? 60 years. Scores of 0-1, 2-3, and 4-5 resulted in predicted PNOs of 30% (7/23), 51% (30/58) and 91% (42/46), and in predicted good neurological outcomes of 69% (16/23), 48% (28/58) and 8% (4/46), respectively. A score of 4-5 had a sensitivity of 53%, specificity of 92%, positive likelihood ratio (LR) of 6.38 and negative LR of 0.51 to predict PNOConclusions: This simple admission score could help to identify early those patients with likely PNO after CPR

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