Added value of the DIC score and of D-dimer to predict outcome after successfully resuscitated out-of-hospital cardiac arrest

Buchtele, Nina; Schober, Andreas; Schoergenhofer, Christian; Spiel, Alexander; Mauracher, Lisa-Marie; Weiser, Christoph; Sterz, Fritz; Jilma, Bernd; Schwameis, Michael

doi:10.1016/j.ejim.2018.06.016

Cited by 20 publications

(22 citation statements)

References 36 publications

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“…Our data show that NETs may be associated with poor neurologic function 30 days after successful resuscitation. In contrast to previously identified coagulation makers associated with poor outcome after cardiac arrest [33,34], NET components may have the potential to serve as therapeutic target structures. NET-targeting agents administered soon after or even during resuscitation could contribute to preventing secondary brain injury and improving neurologic function.…”

Section: Discussionmentioning

confidence: 76%

Increased Citrullinated Histone H3 Levels in the Early Post-Resuscitative Period Are Associated with Poor Neurologic Function in Cardiac Arrest Survivors—A Prospective Observational Study

Mauracher

Buchtele

Schörgenhofer

et al. 2019

JCM

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The exact contribution of neutrophils to post-resuscitative brain damage is unknown. We aimed to investigate whether neutrophil extracellular trap (NET) formation in the early phase after return of spontaneous circulation (ROSC) may be associated with poor 30 day neurologic function in cardiac arrest survivors. This study prospectively included adult (≥18 years) out-of-hospital cardiac arrest (OHCA) survivors with cardiac origin, who were subjected to targeted temperature management. Plasma levels of specific (citrullinated histone H3, H3Cit) and putative (cell-free DNA (cfDNA) and nucleosomes) biomarkers of NET formation were assessed at 0 and 12 h after admission. The primary outcome was neurologic function on day 30 after admission, which was assessed using the five-point cerebral performance category (CPC) score, classifying patients into good (CPC 1–2) or poor (CPC 3–5) neurologic function. The main variable of interest was the effect of H3Cit level quintiles at 12 h on 30 day neurologic function, assessed by logistic regression. The first quintile was used as a baseline reference. Results are given as crude odds ratio (OR) with 95% confidence interval (95% CI). Sixty-two patients (79% male, median age: 57 years) were enrolled. The odds of poor neurologic function increased linearly, with 0 h levels of cfNDA (crude OR 1.8, 95% CI: 1.2–2.7, p = 0.007) and nucleosomes (crude OR 1.7, 95% CI: 1.0–2.2, p = 0.049), as well as with 12 h levels of cfDNA (crude OR 1.6, 95% CI: 1.1–2.4, p = 0.024), nucleosomes (crude OR 1.7, 95% CI: 1.1–2.5, p = 0.020), and H3Cit (crude OR 1.6, 95% CI: 1.1–2.3, p = 0.029). Patients in the fourth (7.9, 95% CI: 1.1–56, p = 0.039) and fifth (9.0, 95% CI: 1.3–63, p = 0.027) H3Cit quintile had significantly higher odds of poor 30 day neurologic function compared to patients in the first quintile. Increased plasma levels of H3Cit, 12 h after admission, are associated with poor 30 day neurologic function in adult OHCA survivors, which may suggest a contribution of NET formation to post-resuscitative brain damage and therefore provide a therapeutic target in the future.

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Section: Discussionmentioning

confidence: 76%

Increased Citrullinated Histone H3 Levels in the Early Post-Resuscitative Period Are Associated with Poor Neurologic Function in Cardiac Arrest Survivors—A Prospective Observational Study

Mauracher

Buchtele

Schörgenhofer

et al. 2019

JCM

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“…DIC is also observed in a significant number of patients with haematological cancers, most often in acute leukaemia, particularly acute promyelocytic leukaemia. Studies also suggested that DIC is relatively frequent in patients resuscitated from out‐of‐hospital cardiac arrest (~10–30%), 14,15 and in patients with head trauma (~30–40%). The prevalence of DIC is considerably lower during pregnancy and among women giving birth in general (<0·5%), 16,17 but increases markedly among patients with pregnancy complications such as placental abruption or amniotic fluid embolism.…”

Section: Epidemiologymentioning

confidence: 99%

Disseminated intravascular coagulation: epidemiology, biomarkers, and management

2021

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Summary Disseminated intravascular coagulation (DIC) is a systemic activation of the coagulation system, which results in microvascular thrombosis and, simultaneously, potentially life‐threatening haemorrhage attributed to consumption of platelets and coagulation factors. Underlying conditions, e.g. infection, cancer, or obstetrical complications are responsible for the initiation and propagation of the DIC process. This review provides insights into the epidemiology of DIC and the current understanding of its pathophysiology. It details the use of diagnostic biomarkers, current diagnostic recommendations from international medical societies, and it provides an overview of emerging diagnostic and prognostic biomarkers. Last, it provides guidance on management. It is concluded that timely and accurate diagnosis of DIC and its underlying condition is essential for the prognosis. Treatment should primarily focus on the underlying cause of DIC and supportive treatment should be individualised according to the underlying aetiology, patient’s symptoms and laboratory records.

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“…6 Interestingly, D-dimer, the most prominent fibrin degradation product and a downstream marker of t-PA release and endogenous fibrinolysis, has been identified as an early predictor for unfavorable outcome and mortality. 3,15 In our population, D-dimer values were also higher in patients with prolonged aPTT and in those with unfavorable outcome. Moreover, D-dimer levels correlated well with aPTT (r ¼ 0.47, p < 0.001).…”

Section: Discussionmentioning

confidence: 51%

“…Early changes in coagulation and the fibrinolytic system following ischemia during resuscitation have recently been linked to unfavorable neurologic outcome after cardiac arrest. [3][4][5][6][7] Conventional activated partial thromboplastin time (aPTT) may be sensitive to these changes, but its value in this context has not been investigated yet.…”

Section: Introductionmentioning

confidence: 99%

Prolonged Activated Partial Thromboplastin Time after Successful Resuscitation from Cardiac Arrest is Associated with Unfavorable Neurologic Outcome

et al. 2020

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Coagulation abnormalities after successful resuscitation from cardiac arrest may be associated with unfavorable neurologic outcome. We investigated a potential association of activated partial thromboplastin time (aPTT) with neurologic outcome in adult cardiac arrest survivors. Therefore, we included all adults ≥18 years of age who suffered a nontraumatic cardiac arrest and had achieved return of spontaneous circulation between January 2013 and December 2018. Patients receiving anticoagulants or thrombolytic therapy and those subjected to extracorporeal membrane oxygenation support were excluded. Routine blood sampling was performed on admission as soon as a vascular access was available. The primary outcome was 30-day neurologic function, assessed by the Cerebral Performance Category scale (3–5 = unfavorable neurologic function). Multivariable regression was used to assess associations between normal (≤41 seconds) and prolonged (>41 seconds) aPTT on admission (exposure) and the primary outcome. Results are given as odds ratio (OR) with 95% confidence intervals (95% CIs). Out of 1,591 cardiac arrest patients treated between 2013 and 2018, 360 patients (32% female; median age: 60 years [interquartile range: 48–70]) were eligible for analysis. A total of 263 patients (73%) had unfavorable neurologic function at day 30. aPTT prolongation >41 seconds was associated with a 190% increase in crude OR of unfavorable neurologic function (crude OR: 2.89; 95% CI: 1.78–4.68, p < 0.001) and with more than double the odds after adjustment for traditional risk factors (adjusted OR: 2.01; 95% CI: 1.13–3.60, p = 0.018). In conclusion, aPTT prolongation on admission is associated with unfavorable neurologic outcome after successful resuscitation from cardiac arrest.

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Added value of the DIC score and of D-dimer to predict outcome after successfully resuscitated out-of-hospital cardiac arrest

Abstract: Overt DIC was rare in a European cohort of out-of-hospital cardiac arrest patients. D-dimer levels improved 30-day mortality prediction and provided added value to assess early mortality risk after successful resuscitation.

Cited by 20 publications

References 36 publications

Increased Citrullinated Histone H3 Levels in the Early Post-Resuscitative Period Are Associated with Poor Neurologic Function in Cardiac Arrest Survivors—A Prospective Observational Study

Increased Citrullinated Histone H3 Levels in the Early Post-Resuscitative Period Are Associated with Poor Neurologic Function in Cardiac Arrest Survivors—A Prospective Observational Study

Disseminated intravascular coagulation: epidemiology, biomarkers, and management

Prolonged Activated Partial Thromboplastin Time after Successful Resuscitation from Cardiac Arrest is Associated with Unfavorable Neurologic Outcome

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