Association between blood urea nitrogen to creatinine ratio and neurologically favourable outcomes in out-of-hospital cardiac arrest in adults: A multicentre cohort study

被引：5

作者：

Nishioka, Norihiro ^{[1
]}

Kobayashi, Daisuke ^{[2
]}

Izawa, Junichi ^{[1
,3
]}

Irisawa, Taro ^{[4
]}

Yamada, Tomoki ^{[5
]}

Yoshiya, Kazuhisa ^{[6
]}

Park, Changhwi ^{[7
]}

Nishimura, Tetsuro ^{[8
]}

Ishibe, Takuya ^{[9
]}

Kobata, Hitoshi ^{[10
]}

Kiguchi, Takeyuki ^{[11
]}

Kishimoto, Masafumi ^{[12
]}

Kim, Sung-Ho ^{[13
]}

Ito, Yusuke ^{[14
]}

Sogabe, Taku ^{[15
]}

Morooka, Takaya ^{[16
]}

Sakamoto, Haruko ^{[17
]}

Suzuki, Keitaro ^{[18
]}

Onoe, Atsunori ^{[19
]}

Matsuyama, Tasuku ^{[20
]}

Okada, Yohei ^{[1
]}

Matsui, Satoshi ^{[21
]}

Yoshimura, Satoshi ^{[1
]}

Kimata, Shunsuke ^{[1
]}

Kawai, Shunsuke ^{[1
]}

Makino, Yuto ^{[1
]}

Zha, Ling ^{[21
]}

Kiyohara, Kosuke ^{[22
]}

Kitamura, Tetsuhisa ^{[21
]}

Iwami, Taku ^{[1
]}

机构：

[1] Kyoto Univ, Sch Publ Hlth, Dept Prevent Serv, Kyoto, Japan

[2] Kyoto Univ, Hlth Serv, Kyoto, Japan

[3] Okinawa Prefectural Chubu Hosp, Dept Internal Med, Div Intens Care Med, Uruma, Okinawa, Japan

[4] Osaka Univ, Grad Sch Med, Dept Traumatol & Acute Crit Med, Suita, Japan

[5] Osaka Police Hosp, Emergency & Crit Care Med Ctr, Osaka, Japan

[6] Kansai Med Univ, Takii Hosp, Dept Emergency & Crit Care Med, Moriguchi, Japan

[7] Tane Gen Hosp, Dept Emergency Med, Osaka, Japan

[8] Osaka Metropolitan Univ, Dept Traumatol & Crit Care Med, Osaka, Japan

[9] Kindai Univ, Sch Med, Dept Emergency & Crit Care Med, Osaka, Japan

[10] Osaka Mishima Emergency Crit Care Ctr, Takatsuki, Japan

[11] Osaka Gen Med Ctr, Crit Care & Trauma Ctr, Osaka, Japan

[12] Osaka Prefectural Nakakawachi Med Ctr Acute Med, Higashiosaka, Japan

[13] Senshu Trauma & Crit Care Ctr, Osaka, Japan

[14] Saiseikai Senri Hosp, Senri Crit Care Med Ctr, Suita, Japan

[15] Natl Hosp Org Osaka Natl Hosp, Traumatol & Crit Care Med Ctr, Osaka, Japan

[16] Osaka City Gen Hosp, Emergency & Crit Care Med Ctr, Osaka, Japan

[17] Osaka Red Cross Hosp, Dept Pediat, Osaka, Japan

[18] Kishiwada Tokushukai Hosp, Emergency & Crit Care Med Ctr, Osaka, Japan

[19] Kansai Med Univ, Dept Emergency & Crit Care Med, Hirakata, Osaka, Japan

[20] Kyoto Prefectural Univ Med, Dept Emergency Med, Kyoto, Japan

[21] Osaka Univ, Grad Sch Med, Dept Social & Environm Med, Div Environm Med & Populat Sci, Osaka, Japan

[22] Otsuma Womens Univ, Dept Food Sci, Tokyo, Japan

来源：

JOURNAL OF CARDIOLOGY | 2023年 / 81卷 / 04期

关键词：

Out-of-hospital cardiac arrest; Blood urea nitrogen; Creatinine; Blood urea nitrogen to creatinine ratio; Cardiopulmonary resuscitation; EUROPEAN-RESUSCITATION-COUNCIL; PUBLIC-ACCESS DEFIBRILLATION; NITROGEN/CREATININE RATIO; GUIDELINES;

D O I：

10.1016/j.jjcc.2022.11.009

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: We aimed to investigate the association between blood urea nitrogen to creatinine ratio (BCR) and survival with favourable neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA). Methods: This prospective, multicentre, observational study conducted in Osaka, Japan enrolled consecutive OHCA patients transported to 16 participating institutions from 2012 through 2019. We included adult patients with non-traumatic OHCA who achieved a return of spontaneous circulation and whose blood urea nitrogen and creatinine levels on hospital arrival were available. Based on BCR values, they were divided into: 'low BCR' (BCR <10), 'normal BCR' (10 <= BCR < 20), 'high BCR' (20 <= BCR < 30), and 'very high BCR' (BCR >= 30). We evaluated the association between BCR values and neurologically favourable outcomes, defined as cerebral performance cate-gory score of 1 or 2 at one month after OHCA. Results: Among 4415 eligible patients, the 'normal BCR' group had the highest favourable neurological outcome [19.4 % (461/2372)], followed by 'high BCR' [12.5 % (141/1127)], 'low BCR' [11.2 % (50/445)], and 'very high BCR' groups [6.6% (31/471)]. In the multivariable analysis, adjusted odds ratios for 'low BCR', 'high BCR', and 'very high BCR' compared with 'normal BCR' for favourable neurological outcomes were 0.58 [95 % confidence interval (CI 0.37-0.91)], 0.70 (95 % CI 0.49-0.99), and 0.40 (95 % CI 0.21-0.76), respectively. Cubic spline analysis indicated that the association between BCR and favourable neurological outcomes was non-linear (p for non-linearity = 0.003). In subgroup analysis, there was an interaction between the aetiology of arrest and BCR in neurological outcome (p for interaction <0.001); favourable neurological outcome of cardiogenic OHCA patients was lower when the BCR was higher or lower, but not in non-cardiogenic OHCA patients. Conclusions: Both higher and lower BCR were associated with poor neurological outcomes compared to normal BCR, especially in cardiogenic OHCA patients. (c) 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

引用

页码：397 / 403

页数：7

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