Thrombotic Microangiopathy Score as a New Predictor of Neurologic Outcomes in Patients after Out-of-Hospital Cardiac Arrest
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Purpose: Given the morphological characteristics of schistocytes, thrombotic microangiopathy (TMA) score can be beneficial asit can be automatically and accurately measured. This study aimed to investigate whether serial TMA scores until 48 h post admissionare associated with clinical outcomes in patients undergoing targeted temperature management (TTM) after out-of-hospitalcardiac arrest (OHCA). Materials and Methods: We retrospectively evaluated a cohort of 185 patients using a prospective registry. We analyzed TMAscores at admission and after 12, 24, and 48 hours. The primary outcome measures were poor neurological outcome at dischargeand 30-day mortality. Results: Increased TMA scores at all measured time points were independent predictors of poor neurological outcomes and 30-day mortality, with TMA score at time-12 showing the strongest correlation [odds ratio (OR), 3.008; 95% confidence interval (CI),1.707–5.300; p<0.001 and hazard ratio (HR), 1.517; 95% CI, 1.196–1.925; p<0.001]. Specifically, a TMA score ≥2 at time-12 was closelyassociated with an increased predictability of poor neurological outcomes (OR, 6.302; 95% CI, 2.841–13.976; p<0.001) and 30-daymortality (HR, 2.656; 95% CI, 1.675–4.211; p<0.001). Conclusion: Increased TMA scores predicted neurological outcomes and 30-day mortality in patients undergoing TTM afterOHCA. In addition to the benefit of being serially measured using an automated hematology analyzer, TMA score may be a helpfultool for rapid risk stratification and identification of the need for intensive care in patients with return of spontaneous circulationafter OHCA.
Abstract
Purpose: Given the morphological characteristics of schistocytes, thrombotic microangiopathy (TMA) score can be beneficial asit can be automatically and accurately measured. This study aimed to investigate whether serial TMA scores until 48 h post admissionare associated with clinical outcomes in patients undergoing targeted temperature management (TTM) after out-of-hospitalcardiac arrest (OHCA). Materials and Methods: We retrospectively evaluated a cohort of 185 patients using a prospective registry. We analyzed TMAscores at admission and after 12, 24, and 48 hours. The primary outcome measures were poor neurological outcome at dischargeand 30-day mortality. Results: Increased TMA scores at all measured time points were independent predictors of poor neurological outcomes and 30-day mortality, with TMA score at time-12 showing the strongest correlation [odds ratio (OR), 3.008; 95% confidence interval (CI),1.707–5.300; p<0.001 and hazard ratio (HR), 1.517; 95% CI, 1.196–1.925; p<0.001]. Specifically, a TMA score ≥2 at time-12 was closelyassociated with an increased predictability of poor neurological outcomes (OR, 6.302; 95% CI, 2.841–13.976; p<0.001) and 30-daymortality (HR, 2.656; 95% CI, 1.675–4.211; p<0.001). Conclusion: Increased TMA scores predicted neurological outcomes and 30-day mortality in patients undergoing TTM afterOHCA. In addition to the benefit of being serially measured using an automated hematology analyzer, TMA score may be a helpfultool for rapid risk stratification and identification of the need for intensive care in patients with return of spontaneous circulationafter OHCA.
참고문헌 (24)
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