The risk factors of short-term prognosis and the construction of nomogram prediction model in the patients with restoration of spontaneous circulation after in-hospital cardiac arrest

Duan Wenhui; Yang Jing; Wang Aiwen; Wang Weiwei; Cheng Yadong; Wang Yangzhou

doi:10.3969/j.issn.1002-1949.2024.03.011

Abstract：Objective To investigate the risk factors of short-term prognosis in the patients with restoration of spontaneous circulation(ROSC)after in-hospital cardiac arrest(IHCA)and to construct a prognosis prediction model based on nomogram.Methods A total of 126 patients with ROSC after IHCA in the Intensive Care Unit of Changzhi People's Hospital from June 2020 to October 2023 were selected as the study objects,and were divided into survival group(n =42)and death group(n =84)according to 7-day prognosis.The baseline clinical data and relevant research indicators of the two groups were collected and compared between the two groups.Logistic regression was used to analyze the relevant variables affecting the 7-day prognosis of patients with ROSC after IHCA.Finally,a nomogram prediction model for the 7-day death of IHCA patients was constructed,and the prediction model was evaluated by C-index,calibration curve and decision curve.Results A total of 126 patients met the inclusion criteria,of which 84 died within 7 days,a mortality rate was 66.67%.Compared with the survival group,the acute physiology and chronic health evaluation(APACHE)Ⅱscore in the death group were significantly increased(P<0.05).Further comparison showed that 6 h lactate(Lac)was significantly higher and the duration of CPR was longer in the death group compared with the survival group(all P<0.05).Compared with the survival group,the number of patients with invasive catheterization,defibrillable rhythm and epinephrine dosage<5 mg in the death group was significantly reduced(all P<0.05).Univariate Logistic regression analysis indicated that APACHEⅡscore,6 h Lac,the duration of CPR,invasive artery,defibrillable rhythm,and the dosage of epinephrine were risk factors for the 7-day death in IHCA patients.Further multivariate Logistic regression analysis indicated that 6 h Lac(OR = 1.243,95%CI 1.085-1.425),invasive artery(OR =5.839,95%CI 1.820-18.734),the duration of CPR(OR =1.084,95%CI 1.023-1.148),defibrillable rhythm(OR =9.418,95%CI 2.596-34.172)and epinephrine dosage(OR = 4.366,95%CI 1.178-16.182)were still independent risk factors affecting the prognosis of patients(all P<0.05).At the same time,the C-index of the nomogram model constructed based on the above indexes was 0.931,with good differentiation,P>0.05 in H-L goodness of fit test,and the calibration curve was close to the ideal curve with high calibration degree.Decision curve analysis(DCA)further proved that the prediction model has good clinical application value.Conclusions 6 h Lac,invasive arteries,the duration of CPR,defibrillable rhythm and the dosage of epinephrine can be used to assess the 7-day risk of death in the patients with ROSC after IHCA.