J Korean Soc Emerg Med.  2015 Feb;26(1):44-50. 10.0000/jksem.2015.26.1.44.

The Relation between Coagulation Profile Test and Outcome in Survivors who were Treated with Therapeutic Hypothermia after Cardiopulmonary Resuscitation

• Lee DH
• Oh JS
• Kim SW
• Choi KH
• Park KN

• KMID: 2191833
• DOI: http://doi.org/10.0000/jksem.2015.26.1.44

Abstract

PURPOSE
The purpose of this study is to clarify the clinical significance of coagulation factor as a prognostic tool in patients with cardiac arrest treated with therapeutic hypothermia (TH).
METHODS
We designed a retrospective case review study in one university hospital. All adult patients who suffered cardiac arrest from December 2011 to February 2014 were considered for inclusion in the study. Patients who did not undergo TH were excluded from the analysis. Patients with any hematologic disorder were also excluded. Patients were divided into two groups, the good outcome group and the poor outcome group depending on the final cerebral performance category (CPC). Serum D-dimer, FDP, PT, aPTT, anti-thrombin III, fibrinogen, Troponin T, CK-MB, Troponin-I, DIC score, NSE, and S-100 were taken within one hour after ROSC. Logistic regression was used for multivariable analysis.
RESULTS
A total of 92 patients were included; 22 in the good outcome group, 70 in the poor outcome group. The median serum PT, aPTT, FDP, fibrinogen, and D-dimer levels were grossly elevated in the poor outcome group. Only serum PT, D-dimer level showed significant association with poor outcome (PT: OR=1.577; 95% CI=1.08-17.49, D-dimer: OR=1.577; 95% CI=1.06-2.33). The area under the receiver operating characteristic (AUC) of PT, D-dimer, and S-100 for prediction of poor outcome was 0.822 (95% CI=0.72-0.89), 0.68 (95% CI=0.57-0.77), and 0.811 (95% CI=0.70-0.89), respectively. Other factors were not associated with prognosis.
CONCLUSION
Increased PT and D-dimer levels are significantly associated with poor outcome. PT and D-dimer values have potential for use as new prognostic predictors along with the current prognostic factor, S-100 protein.

Keyword

Hypothermia; Sudden cardiac death; Prognosis; Blood coagulation factor

MeSH Terms

Adult
Blood Coagulation Factors
Cardiopulmonary Resuscitation*
Dacarbazine
Death, Sudden, Cardiac
Fibrinogen
Heart Arrest
Humans
Hypothermia*
Logistic Models
Prognosis
Retrospective Studies
ROC Curve
S100 Proteins
Survivors*
Troponin I
Troponin T
Blood Coagulation Factors
Dacarbazine
Fibrinogen
S100 Proteins
Troponin I
Troponin T