Study On Risk Factors And Outcome Of Patients With Disturbance Of Consciousness After CPR

Cardiac arrest was a major cause of mortality nowadays,unfortunately more than 50% of hospital patients died even if they had received standardized cardiopulmonary resuscitation(CPR)treatment.Survivors often developed sever neurologic deficits,living with different levels of disturbance of consciousness.Part of patients with acute disturbance of consciousness after CPR would develop to chronic disturbance of consciousness such as minimum state of consciousness(MCS)and vegetative state(VS).Sadly,the preservation of life does not only improve the patient’s prognosis and quality of life,but also increases hospitalization time and aggravates the financial burden on the family members.Therefore,early comprehensive evaluation of brain function in patients with acute disturbance of consciousness after CPR has a good guiding significance for the choice of treatment time and treatment plan,and also helps the clinician communicate with patient’s family more easily.This study aims to use some bedside examination comprehensively,including biochemical tests(Lactate,Calcium),clinical scales(GCS score,APACHE II score,PBSS score,etc.)and electroencephalogram(EEG),to make a more accurate prediction for patients with disturbance of consciousness after CPR.Part One Correlation Analysis of Clinical Characteristics and Prognosis of Patients with Acute Disturbance of Consciousness after CPR1 ObjectiveLooking for the relationship between clinical features and outcomes of patients with disturbance of consciousness after CPR.2 MethodA retrospective cohort study was conducted in the First Affiliated Hospital of Chongqing Medical University,including 53 patients with consciousness disturbance from August 2015 to September 2017.According to the result of patient followed-up for 6 months,Two groups were divided into case groups with GOS score ≤3(i.e.,death,persistent vegetative state,severe disability),GOS score >3(i.e.,good recovery and moderate disability)as control group,and the clinical data was collected.SPSS 22.0 software was used for statistical analysis,all measurement data were first tested for normal distribution,and expressed as mean±standard deviation(`x±s)).Measurement data for independent sample t test,count data for chi-square test,making Logistic regression analysis and calculating ROC curve,p<0.05 is significant.3 Results3.1 Case group(GOS ≤ 3): 17 cases diagnosed of cardiogenic disease,8cases of pulmonary disease,12 cases of neurogenic disease,2 cases of anesthetic accident,2 cases of unexplained causes.And control group(GOS>3): 1 case diagnosed of cardiogenic disease,5 cases of pulmonary disease,3 cases of neurogenic disease and 1 case of anesthetic accident,2cases of unexplained causes.Comparing the etiology of the two groups,the difference was not statistically significant(p>0.05).3.2 The mean age of case group was 61.3±20.0 years old,and the mean age of control group was 43.5±19.2 years old(p<0.05),the difference was statistically significant.Single factor logistic regression analysis revealed that age(b=-0.043,p=0.014,OR=0.958,95% CI: 0.926-0.992)was negatively correlated with outcome,and multivariate logistic regression analysis considered age(b=-0.061,p = 0.011,OR = 0.941,95% CI:0.897-0.986)was an independent risk factor for the evaluation of prognosis.The ROC curve revealed increased age was a good predictor of poor outcomes(AUC=0.742,p=0.011,95% CI: 0.594-0.890).Part Two Correlation Analysis of Clinical Scale Scores,Biochemical Markers and Prognosis in Patients with Disturbance of Consciousness after CPR1 ObjectiveTo analyze the correlation between clinical scale scores(APACHEII,GCS,PBSS),biochemical markers(calcium and lactate)and prognosis in patients with disturbance of consciousness after CPR.2 MethodA retrospective cohort study was conducted enrolling 53 patients.According to the results of patient followed-up for 6 months,patient were divided into case group with GOS score ≤3 and control group with GOS score >3.APACHE II scores,GCS scores,PBSS scores,serum calcium,and Lactate were collected in 72 hours after admission in both groups.Using SPSS 22.0 software for statistical analysis,all measurement data were first tested for normal distribution,and expressed as mean±standard deviation(`x±s)or median±quartile spacing,measurement data for independent sample t test or the rank sum test,and making Logistic regression analysis and calculating ROC curve,p<0.05 is significant.3 Results3.1 the results of clinical scales and biochemical indicators3.1.1 APACHE II score: The mean score of the case group was 30.00±17.00 points.The mean score of the control group was 14.50±5.50 points.The difference was statistically significant(Z=-4.259,p<0.05).3.1.2 GCS score: The mean score of case group was 3.00±3.00 points,and the mean score of control group was 11.50±5.75 points.The difference was statistically significant(Z=-4.485,p<0.05).3.1.3 PBSS score: The mean score of the case group was 6.00±6.00 points,and the mean score of the control group was 12.00± 0.00 points.The difference was statistically significant(Z=-3.881,p<0.05).3.1.4 Calcium: The mean calcium of the case group was 2.01±0.20mmol/L,and the mean calcium of the control group was 2.13±0.37 mmol/L.There was no significant difference(Z=-1.478,p>0.05).3.1.5 Lactate: The mean lactate of the case group was 4.90±10.99 mmol/L,and the mean lactate of the control group was 5.06±4.59 mmol/L.There was no significant difference(Z=-2.770,p>0.05).3.2 Single factor Logistic regression analysisAPACHE II score(b=-0.271,p=0.003,OR=0.762,95%CI:0.637-0.913,AUC=0.907),GCS score(b=0.443,p=0.000,OR=1.557,95 %CI:1.223-1.981,AUC=0.911),PBSS score(b=0.832,p=0.015,OR=2.297,95%CI: 1.175-4.489,AUC=0.841),suggested a correlation with prognosis of patients with disturbance of consciousness after CPR.Part Three Correlation Analysis of EEG and Prognosis in Patients with Disturbance of Consciousness after CPR1 ObjectiveTo investigate the correlation between EEG and prognosis in patients with disturbance of consciousness after CPR2 MethodA retrospective cohort study was conducted enrolling 53 patients.According to the results of patients followed-up for 6 months,patients were divided into case group with GOS score ≤3 and control group with GOS score >3.EEG results(Synek score,characteristic EEG performance,EEG reactivity,sleep waves,etc.)within 72 hours after admission was collected.SPSS 22.0 software was used for statistical analysis,counting data for chi-square test,calculating sensitivity,specificity,positive predictive value,negative predictive value,and ROC curve,p<0.05 is significant.3 Results3.1 EEG results3.1.1 Case group(GOS ≤ 3): There were 35 patients with Synek≥ 3 points in the EEG,6 patients with Synek <3 points.Control group(GOS>3):There were 1 patient with Synek≥ 3 points in the EEG,11 patients with Synek <3 points.Continuous correction chi-square test yielded p<0.05(χ2=21.871,p=0.000),and the difference was statistically significant.3.1.2 Case group(GOS≤3):There were 10 patients with electrocerebral silence in the EEG.And control group(GOS>3): 0 patient with electrocerebral silence.Continuous calibration chi-square test yielded p>0.05(χ2=2.190,p=0.139),with no statistically significant difference.Case group(GOS≤3): There were 10 patients with persistent low voltage in the EEG.And control group(GOS>3): 0 patient with persistent low voltage.Continuous calibration chi-square test yielded p>0.05(χ2=2.190,p=0.139),with no statistically significant difference.Case group(GOS≤3): There were 5 patients with burst-suppression in the EEG.And control group(GOS>3): 0 patient with burst-suppression.Fisher’s exact test yielded p>0.05(χ2=1.616,p=0.577),with no statistically significant difference.Case group(GOS≤3):There were 25 patients whose EEG suggested electrocerebral silence,persistent low voltage or burst-suppression,and 0patient in the control group(GOS>3).Pearson’s chi-square test yielded p<0.05(χ2=13.850,p=0.000),and the difference was statistically significant.3.1.3 Case group(GOS≤3): There were 28 patients without reactivity of EEG.And control group(GOS>3): 0 patient without reactivity of EEG.Pearson chi-square test yielded p<0.05(χ2=17.374,p=0.000),and the difference was statistically significant.3.1.4 Case group(GOS≤3):There were 35 patients without sleep waves.And control group(GOS> 3),there were 3 patients without sleep waves.Continuous calibration chi-square test yielded p<0.05(χ2=13.824,p=0.000),and the difference was statistically significant.3.2 The prediction effect of EEG result3.2.1 Synek≥3 indicated poor prognosis(Se=85%,95%CI:70-94%,Spe=92%,95%CI: 60-100%,PPV=97%,NPV=65%,AUC=0.893).3.2.2 Electrocerebral silence in the electroencephalogram indicated poor outcome(Se=24%,95% CI: 13-41%,Spe = 100%,95% CI:70-100%,PPV =100%,NPV=28%,AUC=0.622).Persistent low voltage in the electroencephalogram indicated poor prognosis(Se=24%,95% CI:13-41%,Spe=100%,95% CI:70-100%,PPV=100%,NPV=28%,AUC=0.622).Burst-suppression in EEG revealed a poor prognosis(Se = 12%,95% CI: 5-27%,Spe=100%,95%CI:70-100%,PPV= 100%,NPV=25%,AUC=0.561).Electrocerebral silence,persistent low voltage or burst-suppression in electroencephalogram indicated poor prognosis(Se=61%,95% CI:45-75%,Spe=100%,95% CI :70-100%,PPV=100%,NPV=43%,AUC=0.805).3.2.3 Absent reactivity of EEG indicated poor outcome(Se = 68%,95% CI:52-81%,Spe = 100%,95% CI: 70-100%,PPV = 100%,NPV = 48%,AUC=0.841).3.2.4 Absent sleep wave of EEG indicated poor prognosis(Se = 85%,95%CI:70-94%,Spe=75%,95%CI:43-93%,PPV=92%,NPV=60%,AUC=0.802).Conclusion1.This study suggested that the age of patients was related to the prognosis of patients with disturbance of consciousness after CPR.And old age might be an independent risk factor for adverse outcomes.2.APACHE II score,GCS score,and PBSS score were effective indicators for evaluating prognosis of patients with disturbance of consciousness after CPR.Higher APACHE II scores and lower GCS scores and PBSS scores all suggested a higher risk of poor outcomes.3."Synek ≥ 3 points" and " absent sleep wave of EEG " indicated that the sensitivity,specificity,and AUC value of the poor prognosis were high,and could be considered as a first-class index for evaluating the prognosis of patients with disturbance of consciousness after CPR."Absent reactivity of EEG " indicated that the sensitivity,specificity,and AUC value of poor prognosis were acceptable,and could be used as a second-class index for evaluating the prognosis of patients with disturbance of consciousness after CPR."Characteristic EEG(electrocerebral silence,persistent low voltage,or burst-suppression,etc.)" was only used as an auxiliary index for evaluating prognosis of patients with disturbance of consciousness after CPR.Single characteristic EEG such as electrocerebral silence,persistent low voltage,and burst-suppression was less sensitive and couldn’t be used as screening markers for evaluating prognosis in patients with disturbance of consciousness after CPR.