Abstract
Background: Postcardiac arrest patients with a return of spontaneous circulation (ROSC) are critically ill, and high body mass index (BMI) is ascertained to be associated with good prognosis in patients with a critically ill condition. However, the exact mechanism has been unknown. To assess the effectiveness of skeletal muscles in reducing neuronal injury after the initial damage owing to cardiac arrest, we investigated the relationship between estimated lean body mass (LBM) and the prognosis of postcardiac arrest patients. Methods: This retrospective cohort study included adult patients with ROSC after out-of-hospital cardiac arrest from January 2015 to March 2020. The enrolled patients were allocated into good- and poor-outcome groups (cerebral performance category (CPC) scores 1–2 and 3–5, respectively). Estimated LBM was categorized into quartiles. Multivariate regression models were used to evaluate the association between LBM and a good CPC score. The area under the receiver operating characteristic curve (AUROC) was assessed. Results: In total, 155 patients were analyzed (CPC score 1–2 vs. 3–5, n = 70 vs. n = 85). Patients’ age, first monitored rhythm, no-flow time, presumed cause of arrest, BMI, and LBM were different (p < 0.05). Fourth-quartile LBM (≥48.98 kg) was associated with good neurological outcome of postcardiac arrest patients (odds ratio = 4.81, 95% confidence interval (CI), 1.10–25.55, p = 0.04). Initial high LBM was also a predictor of good neurological outcomes (AUROC of multivariate regression model including LBM: 0.918). Conclusions: Initial LBM above 48.98kg is a feasible prognostic factor for good neurological outcomes in postcardiac arrest patients.
Highlights
Postcardiac arrest patients with a return of spontaneous circulation (ROSC)are critically ill, and high body mass index (BMI) is ascertained to be associated with good prognosis in patients with a critically ill condition
We excluded pediatric patients younger than 18 years, patients who died within 72 h after undergoing TTM or who died owing to sustained multiple organ failure, patients with poor cerebral performance (cerebral performance category (CPC) score of 3 or 4) before cardiac arrest, patients with inadequate temperature management during TTM, and patients with missing or insufficient data
Among 512 patients with ROSC after cardiac arrest who were treated in the intensive care unit (ICU), 146 patients who did not undergo TTM were excluded
Summary
Postcardiac arrest patients with a return of spontaneous circulation (ROSC)are critically ill, and high body mass index (BMI) is ascertained to be associated with good prognosis in patients with a critically ill condition. Patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest have low survival rates and poor neurological prognosis despite active treatments, such as intensive care unit (ICU) care and targeted temperature management (TTM) [1]. Obesity, which is defined as a body mass index (BMI) ≥ 30 kg/m2 , is considered an important risk factor for cardio-cerebrovascular diseases, metabolic syndrome, overweight, and obese patients have better prognosis in critical conditions, thereby creating an “obesity paradox” [5,6,7]. Improved survival rates and better neurological outcomes were observed in postcardiac arrest patients with relatively higher BMI [8,9,10]. Mechanisms underlying this “obesity paradox” have not been clearly elucidated, the prolicenses/by/4.0/)
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