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PROGNOSTIC IMPACT OF IN-HOSPITAL CARDIAC ARREST RATIO IN PATIENTS WITH IN-HOSPITAL CARDIAC ARREST
349 JACC March 21, 2017 Volume 69, Issue 11
Arrhythmias and Clinical EP PROGNOSTIC IMPACT OF IN-HOSPITAL CARDIAC ARREST RATIO IN PATIENTS WITH IN-HOSPITAL CARDIAC ARREST Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: Arrhythmias and Clinical EP: Ventricular Tachycardia Abstract Category: 6. Arrhythmias and Clinical EP: Other Presentation Number: 1108-081 Authors: Vishal Patel, Rajat Garg, Saroj Neupane, Kesav Parvataneni, Sohail Hassan, St. John Hospital and Medical Center, Detroit, MI, USA
Background: In-hospital cardiac arrest (IHCA) occurs in 209,000 US patients annually (18% survival). Prognostic markers such as IL-6, S-100 and hsCRP have been studied as predictors of survival after return of spontaneous circulation (ROSC); however; cost and lack of equipment make these markers difficult to implement in decision-making. The neutrophil-lymphocyte ratio (NLR) is calculated by dividing the number of neutrophils by the number of lymphocytes. A high NLR has emerged as a marker of poor prognosis for acute coronary syndrome, severe aortic stenosis, venous thromboembolism, atrial fibrillation and certain types of cancers. The prognostic value of NLR in IHCA patients is not known.
Methods: We carried out a retrospective chart review of patients who had an IHCA event from January 1, 2015 to December 31, 2015 and underwent the ACLS protocol at St. John Hospital and Medical Center. Data collection included demographics, initial recorded cardiac rhythm, and complete blood count (CBC) with differential. Data were analyzed using Student’s t-test, the chi-square test, the Mann Whitney U test and receiver operating characteristics (ROC) analysis. Results: Of 330 cases of cardiac arrest reviewed, 153 met inclusion criteria. The mean age of the patients was 66.1 ± 16.3 (s.d.) years and 48.4% (74/153) were female. There were 23 cases of asystole (16.3%), 101 of pulseless electrical activity (71.6%), 11 of ventricular fibrillation (7.8%) and 6 cases of pulseless ventricular tachycardia (4.3%). The median NLR in patients who survived was 4.9 (range 0.646.5) compared to 8.9 in those who died (0.28-96) (p=0.001). From ROC analysis (AUC=0.66), an NLR cutpoint of 4.55 provided 82% sensitivity and 73% specificity. Logistic regression of mortality including age, cardiac rhythm and the NRL cutpoint of 4.55 indicated that mortality increased with age (OR=1.03, p=0.01) and individuals with an NLR greater than 4.55 were 3.8 times more likely to die (OR=3.8, p=0.002). Conclusions: The NLR may be a useful predictor of mortality, as it combines measures of two different immune pathways in response to physiologic and pathologic stress.
Arrhythmias and Clinical EP PROGNOSTIC IMPACT OF IN-HOSPITAL CARDIAC ARREST RATIO IN PATIENTS WITH IN-HOSPITAL CARDIAC ARREST Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: Arrhythmias and Clinical EP: Ventricular Tachycardia Abstract Category: 6. Arrhythmias and Clinical EP: Other Presentation Number: 1108-081 Authors: Vishal Patel, Rajat Garg, Saroj Neupane, Kesav Parvataneni, Sohail Hassan, St. John Hospital and Medical Center, Detroit, MI, USA
Background: In-hospital cardiac arrest (IHCA) occurs in 209,000 US patients annually (18% survival). Prognostic markers such as IL-6, S-100 and hsCRP have been studied as predictors of survival after return of spontaneous circulation (ROSC); however; cost and lack of equipment make these markers difficult to implement in decision-making. The neutrophil-lymphocyte ratio (NLR) is calculated by dividing the number of neutrophils by the number of lymphocytes. A high NLR has emerged as a marker of poor prognosis for acute coronary syndrome, severe aortic stenosis, venous thromboembolism, atrial fibrillation and certain types of cancers. The prognostic value of NLR in IHCA patients is not known.
Methods: We carried out a retrospective chart review of patients who had an IHCA event from January 1, 2015 to December 31, 2015 and underwent the ACLS protocol at St. John Hospital and Medical Center. Data collection included demographics, initial recorded cardiac rhythm, and complete blood count (CBC) with differential. Data were analyzed using Student’s t-test, the chi-square test, the Mann Whitney U test and receiver operating characteristics (ROC) analysis. Results: Of 330 cases of cardiac arrest reviewed, 153 met inclusion criteria. The mean age of the patients was 66.1 ± 16.3 (s.d.) years and 48.4% (74/153) were female. There were 23 cases of asystole (16.3%), 101 of pulseless electrical activity (71.6%), 11 of ventricular fibrillation (7.8%) and 6 cases of pulseless ventricular tachycardia (4.3%). The median NLR in patients who survived was 4.9 (range 0.646.5) compared to 8.9 in those who died (0.28-96) (p=0.001). From ROC analysis (AUC=0.66), an NLR cutpoint of 4.55 provided 82% sensitivity and 73% specificity. Logistic regression of mortality including age, cardiac rhythm and the NRL cutpoint of 4.55 indicated that mortality increased with age (OR=1.03, p=0.01) and individuals with an NLR greater than 4.55 were 3.8 times more likely to die (OR=3.8, p=0.002). Conclusions: The NLR may be a useful predictor of mortality, as it combines measures of two different immune pathways in response to physiologic and pathologic stress.