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Comparison of four clinical risk scores in comatose patients after out-of-hospital cardiac arrest

Schmidbauer, Simon LU orcid ; Rylander, Christian ; Cariou, Alain ; Wise, Matt P. ; Thomas, Matthew ; Keeble, Thomas R. ; Erlinge, David LU orcid ; Haenggi, Matthias ; Wendel-Garcia, Pedro D. and Bělohlávek, Jan , et al. (2023) In Resuscitation 191.
Abstract

Background and aims: Several different scoring systems for early risk stratification after out-of-hospital cardiac arrest have been developed, but few have been validated in large datasets. The aim of the present study was to compare the well-validated Out-of-hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP)-scores to the less complex MIRACLE2- and Target Temperature Management (TTM)-scores. Methods: This was a post-hoc analysis of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Missing data were handled by multiple imputation. The primary outcome was discriminatory performance assessed as the area under the receiver operating characteristics-curve... (More)

Background and aims: Several different scoring systems for early risk stratification after out-of-hospital cardiac arrest have been developed, but few have been validated in large datasets. The aim of the present study was to compare the well-validated Out-of-hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP)-scores to the less complex MIRACLE2- and Target Temperature Management (TTM)-scores. Methods: This was a post-hoc analysis of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Missing data were handled by multiple imputation. The primary outcome was discriminatory performance assessed as the area under the receiver operating characteristics-curve (AUROC), with the outcome of interest being poor functional outcome or death (modified Rankin Scale 4–6) at 6 months after OHCA. Results: Data on functional outcome at 6 months were available for 1829 cases, which constituted the study population. The pooled AUROC for the MIRACLE2-score was 0.810 (95% CI 0.790–0.828), 0.835 (95% CI 0.816–0.852) for the TTM-score, 0.820 (95% CI 0.800–0.839) for the CAHP-score and 0.770 (95% CI 0.748–0.791) for the OHCA-score. At the cut-offs needed to achieve specificities >95%, sensitivities were <40% for all four scoring systems. Conclusions: The TTM-, MIRACLE2- and CAHP-scores are all capable of providing objective risk estimates accurate enough to be used as part of a holistic patient assessment after OHCA of a suspected cardiac origin. Due to its simplicity, the MIRACLE2-score could be a practical solution for both clinical application and risk stratification within trials.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Out-of-hospital cardiac arrest, Outcome, Outcome prediction, Risk prediction, Risk score
in
Resuscitation
volume
191
article number
109949
publisher
Elsevier
external identifiers
  • pmid:37634862
  • scopus:85170430206
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2023.109949
language
English
LU publication?
yes
additional info
Funding Information: The TTM2-trial was supported by independent research grants from nonprofit or governmental agencies (the Swedish Research Council [Vetenskapsrådet], Swedish Heart–Lung Foundation, Stig and Ragna Gorthon Foundation, Knutsson Foundation, Laerdal Foundation, Hans-Gabriel and Alice Trolle-Wachtmeister foundation for medical Research, and regional research Support in Region Skåne) and by governmental funding of clinical research within the Swedish National Health Service. Authors S.S and H.F received regional research support from Region Skåne and funding from the Laerdal Foundation, respectively, for the present work. Funding Information: The TTM2-trial was supported by independent research grants from nonprofit or governmental agencies (the Swedish Research Council [Vetenskapsrådet], Swedish Heart–Lung Foundation , Stig and Ragna Gorthon Foundation , Knutsson Foundation , Laerdal Foundation , Hans-Gabriel and Alice Trolle-Wachtmeister foundation for medical Research , and regional research Support in Region Skåne ) and by governmental funding of clinical research within the Swedish National Health Service. Authors S.S and H.F received regional research support from Region Skåne and funding from the Laerdal Foundation, respectively, for the present work. Publisher Copyright: © 2023 The Author(s)
id
c275246d-eba4-48db-b526-32c7c23af546
date added to LUP
2023-10-18 09:46:04
date last changed
2024-04-19 02:29:13
@article{c275246d-eba4-48db-b526-32c7c23af546,
  abstract     = {{<p>Background and aims: Several different scoring systems for early risk stratification after out-of-hospital cardiac arrest have been developed, but few have been validated in large datasets. The aim of the present study was to compare the well-validated Out-of-hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP)-scores to the less complex MIRACLE2- and Target Temperature Management (TTM)-scores. Methods: This was a post-hoc analysis of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Missing data were handled by multiple imputation. The primary outcome was discriminatory performance assessed as the area under the receiver operating characteristics-curve (AUROC), with the outcome of interest being poor functional outcome or death (modified Rankin Scale 4–6) at 6 months after OHCA. Results: Data on functional outcome at 6 months were available for 1829 cases, which constituted the study population. The pooled AUROC for the MIRACLE2-score was 0.810 (95% CI 0.790–0.828), 0.835 (95% CI 0.816–0.852) for the TTM-score, 0.820 (95% CI 0.800–0.839) for the CAHP-score and 0.770 (95% CI 0.748–0.791) for the OHCA-score. At the cut-offs needed to achieve specificities &gt;95%, sensitivities were &lt;40% for all four scoring systems. Conclusions: The TTM-, MIRACLE2- and CAHP-scores are all capable of providing objective risk estimates accurate enough to be used as part of a holistic patient assessment after OHCA of a suspected cardiac origin. Due to its simplicity, the MIRACLE2-score could be a practical solution for both clinical application and risk stratification within trials.</p>}},
  author       = {{Schmidbauer, Simon and Rylander, Christian and Cariou, Alain and Wise, Matt P. and Thomas, Matthew and Keeble, Thomas R. and Erlinge, David and Haenggi, Matthias and Wendel-Garcia, Pedro D. and Bělohlávek, Jan and Grejs, Anders Morten and Nielsen, Niklas and Friberg, Hans and Dankiewicz, Josef}},
  issn         = {{0300-9572}},
  keywords     = {{Out-of-hospital cardiac arrest; Outcome; Outcome prediction; Risk prediction; Risk score}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Comparison of four clinical risk scores in comatose patients after out-of-hospital cardiac arrest}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2023.109949}},
  doi          = {{10.1016/j.resuscitation.2023.109949}},
  volume       = {{191}},
  year         = {{2023}},
}