Comparison of different clinical risk scores to predict long-term survival and neurological outcome in adults after cardiac arrest: results from a prospective cohort study

Abstract

Background Several scoring systems have been used to predict short-term outcome in patients with out-of-hospital cardiac arrest (OHCA), including the disease-specific OHCA and CAHP (Cardiac Arrest Hospital Prognosis) scores, as well as the general severity-of-illness scores Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II). This study aimed to assess the prognostic performance of these four scores to predict long-term outcomes (≥ 2 years) in adult cardiac arrest patients. Methods This is a prospective single-centre cohort study including consecutive cardiac arrest patients admitted to intensive care in a Swiss tertiary academic medical centre. The primary endpoint was 2-year mortality. Secondary endpoints were neurological outcome at 2 years post-arrest assessed by Cerebral Performance Category with CPC 1–2 defined as good and CPC 3–5 as poor neurological outcome, and 6-year mortality. Results In 415 patients admitted to intensive care, the 2-year mortality was 58.1%, with 96.7% of survivors showing good neurological outcome. The 6-year mortality was 82.5%. All four scores showed good discriminatory performance for 2-year mortality, with areas under the receiver operating characteristics curve (AUROC) of 0.82, 0.87, 0.83 and 0.81 for the OHCA, CAHP, APACHE II and SAPS II scores. The results were similar for poor neurological outcome at 2 years and 6-year mortality. Conclusion This study suggests that two established cardiac arrest-specific scores and two severity-of-illness scores provide good prognostic value to predict long-term outcome after cardiac arrest and thus may help in early goals-of-care discussions.

External validation of the PROLOGUE score to predict neurological outcome in adult patients after cardiac arrest: a prospective cohort study

“…Second, it was explicitly developed for use in IHCA and OHCA patients. Thus, it can be applied to unselected cardiac arrest patients, whereas the OHCA and CAHP score were developed for OHCA patients only and consequentially showed significantly worse performance when applied to IHCA patients in the subgroup analysis—a finding which is in line with previous publications [ 16 , 39 ]. The PROLOGUE score thus might be a promising alternative to the OHCA and CAHP scores mainly due to its better clinical applicability by omitting the no-flow time as a parameter and broader suitability to OHCA and IHCA survivors with—in our study—similar prognostic accuracy.…”

Post-intensive care syndrome and health-related quality of life in long-term survivors of cardiac arrest: a prospective cohort study

“…The study aimed to identify risk factors and prognostic markers for neurological outcomes after cardiac arrest with a maximum follow-up of 24 months. Details of the study’s conduct and procedures have been published previously 4 , 26 – 33 . Patients were treated in accordance with the local treatment protocol, which followed the respective recommendations from the European Resuscitation Council 34 – 36 .…”

Coronary angiography after cardiac arrest

“…And also, skepticism about the use of resource-intensive diagnostic and therapeutic modalities such as CAG with PCI, in comatose patients that might eventually die of irreversible neurological damage [17,18 ▪ ]. Currently, none of the available prognostic instruments [19–21] for early prognostication of these patients has gained universal acceptability as an aid to treatment decisions for these patients [20,22 ▪ ].…”