Abstract
This study investigated the patient outcomes, incidence, and predisposing factors of elevated pancreatic enzyme levels after OHCA. We conducted a retrospective cohort study of patients treated with targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). Elevation of pancreatic enzyme levels was defined as serum amylase or lipase levels that were at least three times the upper limit of normal. The factors associated with elevated pancreatic enzyme levels and their association with neurologic outcomes and mortality 28 days after OHCA were analyzed. Among the 355 patients, 166 (46.8%) patients developed elevated pancreatic enzyme levels. In the multivariable analysis (odds ratio, 95% confidence interval), initial shockable rhythm (0.62, 0.39–0.98, p = 0.04), time from collapse to return of spontaneous circulation (1.02, 1.01–1.04, p < 0.001), and history of coronary artery disease (1.7, 1.01–2.87, p = 0.046) were associated with elevated pancreatic enzyme levels. After adjusting for confounding factors, elevated pancreatic enzyme levels were associated with neurologic outcomes (5.44, 3.35–8.83, p < 0.001) and mortality (3.74, 2.39–5.86, p < 0.001). Increased pancreatic enzyme levels are common in patients treated with TTM after OHCA and are associated with unfavorable neurologic outcomes and mortality at 28 days after OHCA.
Highlights
Despite significant advances in post-cardiac arrest care [1], hospital mortality remains high in patients who experience out-of-hospital cardiac arrest (OHCA) [2,3]
Patients aged
Male sex (OR, 2.96; 95% confidence interval (CI), 1.20–7.28; p = 0.02), bystander CPR (OR, 0.39; 95% CI, 0.19–0.81; p = 0.01), shockable rhythm (OR, 0.44; 95% C,: 0.22–0.85; p = 0.012), time from collapse to ROSC (OR, 1.05; 95% CI, 1.04–1.07; p < 0.001), cardiac cause of arrest (OR, 0.26; 95% CI, 0.12–0.53; p < 0.001), continuous renal replacement therapy (CRRT) application (OR, 3.77; 95% CI, 1.22–11.65; p = 0.02), and elevated pancreatic enzyme levels (OR, 5.44; 95% CI, 3.35–8.83; p < 0.001) were associated with unfavorable neurologic outcomes as determined by multivariable logistic regression analysis (Table 4)
Summary
Despite significant advances in post-cardiac arrest care [1], hospital mortality remains high in patients who experience out-of-hospital cardiac arrest (OHCA) [2,3]. Post-cardiac arrest syndrome is defined by unique and complex combinations of pathophysiological processes after the return of spontaneous circulation (ROSC). It comprises post-cardiac arrest brain injury, myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathology [4]. An animal study reported that ischemia/reperfusion injury of the pancreas caused acute pancreatitis [13]. Polderman [15] reported that hypothermia treatment in post-cardiac arrest syndrome often resulted in elevated levels of amylase in the blood, but the risk of clinically severe pancreatitis was low. Choi et al [16] reported that acute pancreatitis was the most common complication after hypothermia treatment in patients with ROSC after cardiac arrest due to drowning. This study aimed to investigate the incidence of and predisposing factors for elevated serum amylase and/or lipase after OHCA, as well as patient outcomes
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