Influence of stress blood glucose and partial pressure of end-expiratory carbon dioxide on prognosis in patients with cardiopulmonary resuscitation after out-of-hospital cardiac arrest
10.3969/j.issn.1008-9691.2024.05.004
- VernacularTitle:院外心搏骤停心肺复苏后患者院前转运过程中应激性血糖升高及呼气末二氧化碳分压对预后的影响
- Author:
Dong LU
1
;
Yulian SUN
Author Information
1. 无锡市急救中心急救科,江苏无锡 214000
- Publication Type:Journal Article
- Keywords:
Out-of-hospital cardiac arrest;
Cardiopulmonary resuscitation;
Stress hyperglycemia;
Partial pressure of end-expiratory carbon dioxide;
Prognosis
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2024;31(5):544-548
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the predictive value of stress glucose elevation and partial pressure of end-expiratory carbon dioxide (PETCO2) on the prognosis of patients after out-of-hospital cardiac arrest (OHCA) and cardiopulmonary resuscitation (CPR). Methods A total of 221 patients with OHCA after successful CPR admitted to Wuxi Emergency Center from January 2021 to November 2023 were selected as the study subjects. Based on their 28-day prognosis,patients who died or achieved respiratory and heartbeat recovery without regaining consciousness were classified into the poor prognosis group,while the remaining patients were categorized into the good prognosis group. Clinical data were collected,including gender,age,body mass index (BMI),underlying diseases (hypertension,diabetes,hyperlipidemia,coronary heart disease),smoking history,alcohol history,cerebrovascular history,CPR duration,OHCA causes (cardiogenic,non-cardiogenic),acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment (SOFA),Glasgow coma scale (GCS),respiratory rate (RR),heart rate,mean arterial pressure (MAP),body temperature,white blood cell count (WBC),red blood cell count (RBC),platelet count (PLT),blood lactate (Lac),procalcitonin (PCT),C-reactive protein (CRP),serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),urea nitrogen (BUN),serum creatinine (SCr),fibrinogen (Fib),D-dimer and epinephrine dose,presence or absence of hypothermia therapy,duration of mechanical ventilation,ICU stay time and stress glucose elevation ratio (SHR),PETCO2,etc.,and the differences in clinical data between the two groups were compared. The Logistic regression model was used to analyze the factors affecting the short-term prognosis of OHCA patients after successful CPR,and the receiver operator characteristic curve (ROC curve) was used to evaluate the predictive performance of each influencing factor on the prognosis of patients. Results Finally,221 patients with OHCA after successful CPR were included,40 had a good prognosis and 181 had a poor prognosis. The SHR,APACHEⅡ score,SOFA score,Lac,epinephrine dosage>5 mg ratio,and ICU stay in the poor prognosis group were higher than those in the good prognosis group[SHR:1.19±0.14 vs. 1.02±0.09,APACHEⅡ score:23.01±3.15 vs. 17.01±2.41,SOFA score:8.62±1.09 vs. 6.32±0.98,Lac (mmol/L):10.32±1.69 vs. 7.01±1.02,epinephrine dosage>5 mg ratio:67.96％ (123/181) vs. 45.00％ (18/40),ICU stay time (days):8.59±1.42 vs. 8.01±1.53,all P<0.05],PETCO2 and GCS scores were lower than those in the good prognosis group[PETCO2 (mmHg,1 mmHg≈0.133 kPa):20.04±2.83 vs. 34.92±3.01,GCS score:3.82±0.43 vs. 5.04±0.82,both P<0.05]. Logistic regression analysis showed that APACHEⅡ score,GCS score,SHR,and PETCO2 were all factors affecting the short-term prognosis of OHCA patients after successful CPR[odds ratios (OR) were 6.385,0.421,4.133,and 0.659,respectively,and 95％ confidence interval (95％CI) were 2.627-15.518,0.173-1.023,1.701-10.045,and 0.271-1.602,respectively,P values were all 0.000]. ROC curve analysis showed that SHR,PETCO2 and their combined tests had predictive value for the short-term prognosis of OHCA patients after successful CPR[area under the curve (AUC) and 95％CI were 0.705 (0.591-0.819),0.723 (0.612-0.834),0.886 (0.817-0.954),and the sensitivities were 65.19％,70.17％,and 85.08％,respectively,the specificities were 70.00％,77.50％ and 87.50％,and the P values were 0.012,0.005 and 0.000,respectively]. Conclusion Stress blood glucose elevation and PETCO2 were associated with the prognosis of OHCA patients during prehospital transport after successful CPR,and SHR combined with PETCO2 had good prognostic efficacy in predicting OHCA patients after successful CPR.
