Evaluation index in predicting the prognosis of critical patients post cardiopulmonary resuscitation

Abstract

Objective To assess the early prognosis of 117 patients after carduopulmonary resuscitation (CPR) in ICU by using the markers of inflammation, Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores. Methods A total of 117 CPR patients admitted between 2010 January to 2012 December were enrolled for study. Within 24 h after admission, inflammatory markers, blood routine items, hepatorenal function, electrolytes of blood were measured. The GCS and APACHE Ⅱ scores were recorded. Arterial blood gas analyses were performed at 0, 12, and 24 h after hospitalization, and the 12-h and 24-h lactate clearance rates were calculated. Seven days after treatment, according to the outcomes, the patients were divided into survival group and death group, and the clinical data of two groups were analyzed. Results (1) Of them, 73 patients died and 44survived. Factor analysis showed that age, time elapsed from resuscitation to ICU admission, D-dimer, arterial oxygenation index (FiO2) , arterial blood pH, arterial blood lactate concentration upon ICU admission, GCS score and APACHE Ⅱ score were significantly different between the two groups (P <0.05 orP <0.01) ; (2) Two classification logistic regression analysis showed that D-Dimer, GCS score and APACHE Ⅱ score significantly correlated with the mortality risk of the patients in the wake of CPR with relative odds ratios of 1.000 , 2.091 , and 0.531 , respectively (P <0.05 orP <0.01) ; (3) Receiver operating characteristic curve analysis indicated that the area under the curve of GCS (0.821) and APACHE Ⅱ (0.869) had higher predictive value than D-dimer (0.655 ). The highest accuracy (84.6%) in predicting patient survival was achieved when the GCS score was 6.5. Meanwhile, the highest accuracy (82.1%) in predicting patient death was achieved when the APACHE Ⅱ score was 17.5. Conclusions Both GCS score and APACHE Ⅱ score has obvious correlation with the prognosis of the critically ill patients after CPR and could be used to predict prognosis at early stage. Key words: Cardiopulmonary resuscitation; Glasgow coma scale; Acute physiology and chronic Health Evaluation Ⅱ; Prognosis