Effect of Serum Albumin Concentration on Neurological Outcome After Out-of-Hospital Cardiac Arrest (from the CRITICAL [Comprehensive Registry of Intensive Cares for OHCA Survival] Study in Osaka, Japan) - 21/12/17

Doi : 10.1016/j.amjcard.2017.10.005

Tasuku Matsuyama, MD ^a, Taku Iwami, MD ^b, Tomoki Yamada, MD ^c,^d, Koichi Hayakawa, MD ^e, Kazuhisa Yoshiya, MD ^c, Taro Irisawa, MD ^c, Yoshio Abe, MD ^f, Tetsuro Nishimura, MD ^g, Toshifumi Uejima, MD ^h, Yasuo Ohishi, MD ⁱ, Takeyuki Kiguchi, MD ^b,^j, Masashi Kishi, MD ^d, Masafumi Kishimoto, MD ^k, Shota Nakao, MD ^l, Yasuyuki Hayashi, MD ^m, Taku Sogabe, MD ⁿ, Takaya Morooka, MD ^o, Junichi Izawa, MD ^b, Tomonari Shimamoto, MD ^b, Toshihiro Hatakeyama, MD ^b, Tomoko Fujii, MD ^b, Junya Sado, MPH ^p, Takeshi Shimazu, MD ^c, Takashi Kawamura, MD ^b, Tetsuhisa Kitamura, MD ^p,^*
^a Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
^b Kyoto University Health Services, Kyoto, Japan
^c Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
^d Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan
^e Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan
^f Department of Emergency Medicine, Tane General Hospital, Osaka, Japan
^g Department of Traumatology and Critical Care Medicine, Osaka City University, Osaka, Japan
^h Department of Emergency and Critical Care Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan
ⁱ Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan
^j Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan
^k Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-Osaka, Japan
^l Senshu Trauma and Critical Care Center, Osaka, Japan
^m Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
ⁿ Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
^o Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
^p Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan

^*Corresponding author: Tel: +81-6-6879-3922; fax: +81-6-6879-2929.

Abstract

The aim of this study was to assess whether serum albumin concentration upon hospital arrival had prognostic indications on out-of-hospital cardiac arrest (OHCA). This prospective, multicenter observational study conducted in Osaka, Japan (the CRITICAL [Comprehensive Registry of Intensive Cares for OHCA Survival] study), enrolled all patients with consecutive OHCA transported to 14 participating institutions. We included adult patients aged ≥18 years with nontraumatic OHCA who achieved return of spontaneous circulation and whose serum albumin concentration was available from July 2012 to December 2014. Based on the serum albumin concentration upon hospital arrival, patients were divided into quartiles (Q1 to Q4), namely, Q1 (<2.7 g/dl), Q2 (2.7 to 3.1 g/dl), Q3 (3.1 to 3.6 g/dl), and Q4 (≥3.6 g/dl). The primary outcome was 1-month survival with favorable neurological outcome (cerebral performance category scale 1 or 2). During the study period, a total of 1,269 patients with OHCA were eligible for our analyses. The highest proportion of favorable neurological outcome was 33.5% (109 of 325) in the Q4 group, followed by 13.2% (48 of 365), 5.0% (13 of 261), and 3.5% (11 of 318) in the Q3, Q2, and Q1 groups, respectively. In the multivariable logistic regression analysis, the proportion of favorable neurological outcome in the Q4 group was significantly higher, compared with that in the Q1 group (adjusted odds ratio 8.61; 95% confidence interval 4.28 to 17.33). The adjusted proportion of favorable neurological outcome increased in a stepwise manner across increasing quartiles (p for trend <0.001). Higher serum albumin concentration was significantly and independently associated with favorable neurological outcome in a dose-dependent manner.

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	Funding sources: This study was supported by a scientific research grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan 16K09034 and 15H05006 (Tokyo, Japan).
	See page 161 for disclosure information.

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Vol 121 - N° 2

P. 156-161 - janvier 2018 Retour au numéro

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Effect of Serum Albumin Concentration on Neurological Outcome After Out-of-Hospital Cardiac Arrest (from the CRITICAL [Comprehensive Registry of Intensive Cares for OHCA Survival] Study in Osaka, Japan) - 21/12/17

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