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Charlson Comorbidity Score Is Not Predictive of Neurologic Outcomes in Cardiac Arrest Following Hypothermia
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A6037 - Charlson Comorbidity Score Is Not Predictive of Neurologic Outcomes in Cardiac Arrest Following Hypothermia
Author Block: J. Aguilera1, L. Harper2, A. L. Schenone3, G. Patarroyo4, X. Han5, X. Wang5, C. Aaron2, J. A. Guzman2, A. Duggal2; 1Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States, 2Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States, 3Department of Cardiovascular Medicine, Heart and Vascular Insitute, Cleveland Clinic, Cleveland, OH, United States, 4New York Medical College, MHC., New York, NY, United States, 5Cleveland Clinic, Cleveland, OH, United States.
Background: Recent studies have had conflicting results regarding the predictive power of the age adjusted-Charlson comorbidity (ACCI) index for outcomes following cardiac arrest. Aim: To assess age, Charlson comorbidity (CCI) index and ACCI for predictive power of functional status on discharge following in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) treated with mild therapeutic hypothermia (MTH) Materials and Methods: A retrospective chart review of 379 consecutive patients treated with MTH between 12/29/11 to 1/4/15 at Cleveland Clinic was carried out. Information regarding comorbidities, demographics, cardiac arrest statistics (time to return of spontaneous circulation (ROSC), bystander CPR, etc) was collected. Univariate and multivariate analysis were performed. Results: Neither age [OR 0.99 (0.96-1.03)], CCI [OR 0.94 (0.79-1.13)] nor ACCI [OR 0.95 (0.82-1.09)] were significantly associated with functional status at discharge in multivariate analysis. Only initially shockable rhythm [OR 15.1 (5.62-41.7)], bystander CPR [OR 4.30 (1.53-12.03)] and temperature management of 34-36°C instead of 32-34°C [OR 1.78 (1.28-2.47)] was associated with favorable CPC at discharge. This remained true when age was stratified to >70 vs. ≤70 [OR 1.11 (0.37-3.39)] or >55 vs. ≤55 [OR 1.25 (0.45-3.44)] as well as when ACCI was stratified to >4 vs. ≤4 [OR 1.25 (0.46-3.34)] or >6 vs. ≤6 [1.58 (0.59-4.23)]. Conclusion: In this sample, age and comorbidity burden, as assessed by the CCI, were not predictive of favorable outcome following cardiac arrest treated with MTH, even for patients at the extremes of age and comorbidity burden. Initial rhythm remained the strongest predictor of neurologic outcome.
Author Block: J. Aguilera1, L. Harper2, A. L. Schenone3, G. Patarroyo4, X. Han5, X. Wang5, C. Aaron2, J. A. Guzman2, A. Duggal2; 1Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States, 2Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States, 3Department of Cardiovascular Medicine, Heart and Vascular Insitute, Cleveland Clinic, Cleveland, OH, United States, 4New York Medical College, MHC., New York, NY, United States, 5Cleveland Clinic, Cleveland, OH, United States.
Background: Recent studies have had conflicting results regarding the predictive power of the age adjusted-Charlson comorbidity (ACCI) index for outcomes following cardiac arrest. Aim: To assess age, Charlson comorbidity (CCI) index and ACCI for predictive power of functional status on discharge following in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) treated with mild therapeutic hypothermia (MTH) Materials and Methods: A retrospective chart review of 379 consecutive patients treated with MTH between 12/29/11 to 1/4/15 at Cleveland Clinic was carried out. Information regarding comorbidities, demographics, cardiac arrest statistics (time to return of spontaneous circulation (ROSC), bystander CPR, etc) was collected. Univariate and multivariate analysis were performed. Results: Neither age [OR 0.99 (0.96-1.03)], CCI [OR 0.94 (0.79-1.13)] nor ACCI [OR 0.95 (0.82-1.09)] were significantly associated with functional status at discharge in multivariate analysis. Only initially shockable rhythm [OR 15.1 (5.62-41.7)], bystander CPR [OR 4.30 (1.53-12.03)] and temperature management of 34-36°C instead of 32-34°C [OR 1.78 (1.28-2.47)] was associated with favorable CPC at discharge. This remained true when age was stratified to >70 vs. ≤70 [OR 1.11 (0.37-3.39)] or >55 vs. ≤55 [OR 1.25 (0.45-3.44)] as well as when ACCI was stratified to >4 vs. ≤4 [OR 1.25 (0.46-3.34)] or >6 vs. ≤6 [1.58 (0.59-4.23)]. Conclusion: In this sample, age and comorbidity burden, as assessed by the CCI, were not predictive of favorable outcome following cardiac arrest treated with MTH, even for patients at the extremes of age and comorbidity burden. Initial rhythm remained the strongest predictor of neurologic outcome.
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