Simplistic approach to prognosis after cardiopulmonary resuscitation--value of pH and lactate
Journal of Critical Care, 07/27/2012
Seeger FH et al. – A combination of clinical data and broadly available parameters can help to stratify prognosis of patients after cardiopulmonary resuscitation with sufficiently high predictive value. Interestingly, a combination of the 3 parameters—age more than 65years, high lactate, and low pH upon admission—had a sensitivity of 1.0 for a poor outcome after return of spontaneous circulation.Methods
- The authors analyzed patients with status postresuscitation who were admitted to the Frankfurt University hospital.
- Arterial pH and serum lactate levels were dichotomized as “high” or “low.”
- Primary end point was a combination of death or severe hypoxic brain damage within 30days.
- In total, 67% of 206 patients (66±12years) reached the primary end point.
- Univariate analysis showed that age more than 65years (hazard ratio [HR] 1.7; 95% confidence interval (CI), 1.2–2.4), high lactate (>6.94mmol/L [62.5mg/dL)]; HR 2.8; 95% CI 2.0–3.9), and low pH (<7.21; HR 2.7; 95% CI 1.9–3.8) on admission were associated with the end point.
- Upon multivariate analysis, age more than 65years, high lactate, and low pH on admission remained as independent predictors.
- Specificity and sensitivity to detect patients with an end point were 0.51 and 1.0 for the combination of low pH, high lactate, and age more than 65years (negative predictive value, 1.0).