Pilot analysis of the usefulness of mortality risk score systems at resuscitated patients

Osszefoglalo. Bevezetes: A cardiovascularis halalokok kozul vilagszerte nagy jelentősegű a hirtelen szivhalal. Annak ellenere, hogy a cardiopulmonalis resuscitatio es a postresuscitatios intenziv osztalyos kezeles is komoly metodikai es technikai fejlődesen ment keresztul az elmult időszakban, keves az olyan validalt pontrendszer, amely jol becsulne a beteg intenziv osztalyra kerulesekor a mortalitasi rizikot. Celkitűzes: A sikeres ujraelesztest kovető intenziv osztalyos kezeles kezdetekor felmert, a cardiogen shock rizikostratifikaciojara alkalmazott CardShock Risk Score (CSRS) es az altalunk hozzaadott, specifikus sulyozofaktorokkal (inicialis ritmus, inotropigeny) modositott CardShock Risk Score (mCSRS) osszevetese a mortalitas előrejelzeseben post-cardiac arrest szindromas betegeknel. Modszerek: Retrospektiv vizsgalatunk soran 172, korhazon kivul sikeresen ujraelesztett es klinikankon ellatott consecutiv betegből a CSRS- es mCSRS-pontrendszerek segitsegevel vegul 123 beteg adatait elemeztuk. A CSRS- es mCSRS-valtozok es a korai/kesői mortalitas kozotti osszefuggest Cox-regresszios analizissel vizsgaltuk. A pontszamok alapjan 3 csoportba (1-3, 4-6, 7+) soroltuk a betegeket. Az osszevont csoportok tuleleset log-rank teszttel hasonlitottuk ossze. Eredmenyek: A betegpopulacio atlageletkora 63,6 ev volt (69% ferfi), es a hirtelen szivhalal hattereben 80%-ban akut coronaria szindroma allt. A korai/kesői mortalitast leginkabb a felvetel utani neurologiai allapot, a szerumlaktatszint, a vesefunkcio, az inicialis ritmus es a beteg katecholaminigenye hatarozta meg. A mCSRS alkalmazasat kovetően mind az "1-3" es a "4-6" (p≤0,001), mind a "4-6" es a "7+" (p = 0,006) csoportok kozott szignifikans kulonbseget talaltunk a tulelesben. Kovetkeztetes: A felvetelkori pontok alapjan a mCSRS pontosabban definialja es differencialja egymastol az altalunk bevalasztott ket extra sulyozofaktorral az enyhe, a kozepes es a magas mortalitasi rizikoval biro betegpopulaciokat, mint a CSRS. Orv Hetil. 2021; 162(2): 52-60. Introduction Sudden cardiac death is one of the most significant cardiovascular causes of death worldwide. Although there have been immense methodological and technical advances in the field of cardiopulmonary resuscitation and following intensive care in the last decade, currently there are only a few validated risk-stratification scoring systems for the quick and reliable estimation of the mortality risk of these patients at the time of admission to the intensive care unit. Objective Our aim was to correlate the mortality prediction risk points calculated by CardShock Risk Score (CSRS) and modified (m) CSRS based on the admission data of the post-cardiac arrest syndrome (PCAS) patients. Methods The medical records of 172 out-of-hospital resuscitated cardiac arrest patients, who were admitted at the Heart and Vascular Centre of Semmelweis University, were screened retrospectively. Out of the 172 selected patients, 123 were eligible for inclusion to calculate CSRS and mCSRS. Based on CSRS score, we generated three different groups of patients, with scores 1 to 3, 4 to 6, and 7+, respectively. Mortality data of the groups were compared by log-rank test. Results Mean age of the patients was 63.6 years (69% male), the cause of sudden cardiac death was acut coronary syndrome in 80% of the cases. The early and late mortality was predicted by neurological status, serum lactate level, renal function, initial rhythm, and the need of catecholamines. Using mCSRS, a significant survival difference was proven in between the groups "1-3" vs "4-6" (p≤0.001), "4-6" vs "7+" (p = 0.006). Conclusion Compared to the CSRS, the mCSRS expanded with the 2 additional weighting points differentiates more specifically the low-moderate and high survival groups in the PCAS patient population treated in our institute. Orv Hetil. 2021; 162(2): 52-60.