Predictive factors of favorable neurologic function after out-of-hospital cardiac arrest and establishment of decision tree prediction model
Liu Dongming
Feng Shunyi
Wang Shujuan
Li Yong
Abstract：Objective To identify the predictive factors of favorable neurologic function after out-of-hospital cardiac arrest(OHCA)and to establish decision tree prediction model.Methods Clinical data of 117 OHCA patients with successful cardiopulmonary resuscitation(CPR)treated in EICU of Cangzhou Central Hospital from January 2018 to December 2022 were retrospectively analyzed.The patients were divided into favorable neurologic function group(1-2 grades)or poor neurologic function group(3-5 grades)according to the Glasgow-Pittsburgh cerebral performance category 3 months after OHCA.The univariate and multivariate Logistic regression was used to analyze the predictive factors for favorable neurologic function,and decision tree prediction model was established based on predictive factors.The discrimination performance of the decision tree prediction model was assessed by the area under the receiver operating characteristic(AUC)curve,the consistency between the actual outcomes and the predicted probabilities was estimated by the calibration curve,and the clinical practical utility was assessed by the decision curve analysis.Results There were29.1%(34/117)OHCA patients with favorable neurologic function.Compared with poor neurologic function group,the patients with favorable neurological function had the higher incidence of receiving bystander CPR(χ2 =4.81,P = 0.028),the higher proportion of shockable rhythm(χ2 = 8.74,P = 0.003),the shorter CPR duration(Z =3.36,P =0.001),the less dosage of epinephrine(Z =4.69,P<0.001),and the lower lactate levels(Z =3.83,P<0.001).Univariate Logistic regression analysis showed that bystander CPR(OR =0.34,95%CI 0.13-0.92,P =0.033),shockable rhythm(OR =0.20,95%CI 0.07-0.63,P =0.006),CPR time(OR =1.08,95%CI 1.02-1.14,P =0.010),epinephrine dosage(OR =1.64,95%CI 1.28-2.09,P<0.001),and serum lactate(OR =1.20,95%CI 1.09-1.33,P<0.001)were independent predictive factors for favorable neurologic function in OHCA patients.Multivariate Logistic regression analysis showed that shockable rhythm(OR =0.25,95%CI 0.06-0.95,P =0.041),CPR time(OR =1.07,95%CI 1.00-1.14,P =0.047),epinephrine dosage(OR =1.95,95%CI 1.29-2.94,P =0.001),and serum lactate(OR =1.13,95%CI 1.01-1.26,P = 0.042)were independent predictive factors for favorable neurologic function in OHCA patients.The AUC of the decision tree prediction model for predicting favorable neurologic function in OHCA patients was 0.829(95%CI 0.745-0.912),with sensitivity of 70.6%and specificity of 86.7%.Calibration curves showed good consistency between the predicted probabilities and the observed outcome.Decision curve analysis confirmed the clinical usability of the decision tree prediction model.Conclusions The shockable rhythm,CPR time,epinephrine dosage,and serum lactate are independent predictive factors for favorable neurologic function,and decision tree prediction model can predict favorable neurologic function in OHCA patients.
Keywords：Cardiac arrestCardiopulmonary resuscitation durationNeurologic functionDecision treeSerum lactic acidEpinephrine
Publication Date：2024-01-10
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 57-62 )