Initial red cell distribution width as a predictor of poor neurological outcomes in out-of-hospital cardiac arrest survivors in a prospective, multicenter observational study (the KoCARC study)

Seon Hee Woo,Woon Jeong Lee,Youngsuk Cho,Gyu Chong Cho,Dae Hee Kim

doi:10.1038/s41598-020-74842-y

Seon Hee Woo, Woon Jeong Lee + Show 3 more

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https://doi.org/10.1038/s41598-020-74842-y

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Journal: Scientific Reports	Publication Date: Oct 16, 2020
Citations: 3	License type: open-access

Affiliation: Incheon St. Mary's Hospital, Hallym University

Abstract

This study aimed to investigate whether the initial red cell distribution width (RDW) at the emergency department (ED) is associated with poor neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors. We performed a prospective observational analysis of patients admitted to the ED between October 2015 and June 2018 from the Korean Cardiac Arrest Research Consortium registry. We included OHCA patients who visited the ED and achieved return of spontaneous circulation. Initial RDW values were measured at the time of the ED visit. The primary outcome was a poor neurological (Cerebral Performance Category, or CPC) score of 3–5. A total of 1008 patients were ultimately included in this study, of whom 712 (70.6%) had poor CPC scores with unfavorable outcomes. Higher RDW quartiles (RDW 13.6–14.9%, RDW ≥ 15.0%), older age, female sex, nonshockable initial rhythm at the scene, unwitnessed cardiac arrest, bystander cardiopulmonary resuscitation (CPR), medical history, low white blood cell counts and high glucose levels were associated with poor neurological outcomes in univariate analysis. In multivariate analysis, the highest RDW quartile was independently associated with poor neurological outcomes (odds ratio 2.04; 95% confidence interval 1.12–3.69; p = 0.019) at hospital discharge after adjusting for other confounding factors. Other independent factors including age, initial rhythm, bystander CPR and high glucose were also associated with poor neurological outcomes. These results show that an initial RDW in the highest quartile as of the ED visit is associated with poor neurological outcomes at hospital discharge among OHCA survivors.

Highlights

Out-of-hospital cardiac arrest (OHCA) is becoming an issue worldwide, and a considerable amount of research is being conducted on factors related to s urvival[1,2,3]
Of the 7577 OHCA patients examined during this research period, 5249 were excluded because they did not survive to hospital admission
The present study showed that red cell distribution width (RDW) ≥ 15% was an independent predictor of poor Cerebral Performance Category (CPC) scores at hospital discharge in OHCA survivors

Summary

Introduction

Out-of-hospital cardiac arrest (OHCA) is becoming an issue worldwide, and a considerable amount of research is being conducted on factors related to s urvival[1,2,3]. Many OHCA survivors show poor neurological outcomes at discharge[1,2]. For the critical care management of OHCA survivors in EDs, the early prediction of neurological outcomes and mortality is important for decision making by emergency medicine (EM) physicians in active and intensive care. Poor neurological outcomes in OHCA survivors are associated with ischemic reperfusion injury of the brain and can cause an increase in various inflammatory markers associated with sepsis-like physiological mechanisms of OHCA18. Few studies have used multicenter research data to investigate whether RDW is a prognostic factor predicting poor neurological o utcomes[21].

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