Introduction
Materials and methods
Study population
Clinical evaluation and outcomes
Laboratory variables
Statistical analysis
Results
Gender, M, n (%) | 84 (71.8) |
---|---|
Age (yr) | 52(44 to 64) |
BLS time (minutes) | 5 (2 to 10) |
Arrest time (minutes) | 36 (21 to 51) |
Epinephrine (mg) | 3 (2 to 8) |
HTN, yes, n (%) | 33 (28.2) |
DM, yes, n (%) | 13 (11.1) |
APACHE II | 23 (20 to 27) |
SOFA | 10 (8 to 11) |
Lactate (mmol/L) | 8.7 (6.6 to 11.8) |
Cortisol, basal (μg/dL) | 24.91 (15.00 to 37.36) |
Cortisol, 30 minutes (μg/dL) | 28.73 (22.71 to 40.19) |
Cortisol, 60 minutes (μg/dL) | 29.56 (23.49 to 42.76) |
RAI, Yes, n (%) | 49 (41.9%) |
ACTH (pg/mL) | 5.40 (1.24 to 23.94) |
ADH (pg/mL) | 22.11 (12.42 to 35.19) |
Survivors, at 1 wk | 87 (74.4%) |
Survivors, at 1 mo | 65 (55.6%) |
CPC, good, n (%) | 35 (29.9%) |
RAI | 1 wk mortality | 1 mo mortality | CPC | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Yes |
No | P-value |
Survived |
Dead | P- value |
Survived |
Dead | P- value |
Good |
Poor | P- value | |
(n = 68) |
(n = 49) |
(n = 87) |
(n = 30) |
(n = 65) |
(n = 52) |
(n = 35) |
(n = 82) | |||||
Gender, M, n (%) | 49 (72.1) | 35 (71.4) | 0.940 | 62 (71.3) | 22 (73.3) | 0.828 | 49 (75.4) | 35 (67.3) | 0.335 | 31 (88.6) | 53 (64.6) | 0.008* |
Age (yr) | 52 | 53 | 0.772 | 52 | 54 | 0.422 | 49 | 56 | 0.174 | 47 | 56 | 0.010* |
BLS time (minutes) | 6 | 4 | 0.076 | 5 | 6 | 0.093 | 5 | 6 | 0.207 | 4 | 6 | 0.200 |
Arrest time (minutes) | 40 | 27 | 0.004* | 31 | 50 | <0.001* | 25 | 44 | <0.001* | 25 | 38 | 0.010* |
Epinephrine (mg) | 5 | 2 | <0.001* | 3 | 7 | 0.001* | 3 | 5 | 0.004* | 3 | 4 | 0.338 |
HTN, yes, n (%) | 18 (26.5) | 15 30.6) | 0.507 | 22 (25.3) | 11 (36.7) | 0.194 | 18 (27.7) | 15 (28.8) | 0.804 | 9 (25.7) | 24 (29.3) | 0.668 |
DM, yes, n (%) | 6 (8.8) | 7 (14.3) | 0.283 | 8 (9.2) | 5 (16.7) | 0.298 | 5 (7.7) | 8 (15.4) | 0.152 | 1 (2.9) | 12 (14.6) | 0.102 |
APACHE II | 23 | 22 | 0.889 | 22 | 27 | 0.001* | 22 | 26 | <0.001* | 31 | 26 | <0.001* |
SOFA | 10 | 9 | 0.062 | 9 | 12 | <0.001* | 9 | 11 | 0.001* | 9 | 10 | 0.029* |
Lactate (mmol/L) | 9.40 | 7.55 | 0.013* | 8.50 | 9.40 | 0.244 | 8.40 | 9.35 | 0.190 | 8.30 | 8.90 | 0.393 |
Cortisol, basal (μg/dL) | 27.33 | 16.70 | <0.001* | 25.05 | 24.10 | 0.762 | 22.74 | 25.57 | 0.204 | 20.45 | 25.95 | 0.030* |
Cortisol, 30 minutes (μg/dL) | 28.74 | 28.54 | 0.543 | 28.89 | 27.35 | 0.380 | 28.29 | 29.54 | 0.584 | 26.45 | 29.32 | 0.273 |
Cortisol, 60 minutes (μg/dL) | 29.12 | 32.46 | 0.100 | 29.67 | 24.64 | 0.154 | 29.20 | 30.74 | 0.946 | 29.02 | 31.53 | 0.572 |
ACTH (μg/dL) | 7.85 | 2.12 | 0.006* | 2.60 | 11.79 | 0.005* | 2.35 | 9.41 | 0.002* | 2.31 | 7.85 | 0.014* |
ADH (pg/mL) | 24.97 | 17.11 | 0.031* | 19.81 | 28.65 | 0.037* | 18.16 | 28.27 | 0.004* | 14.42 | 24.80 | 0.001* |
Factors | P- value | Odds ratio | 95% CI of odds ratio | Observed power | |
---|---|---|---|---|---|
Lower |
Upper | ||||
Age ≧50 yr | 0.221 | 1.784 | 0.705 | 4.510 | 0.261 |
RAI (+) | 0.046 | 2.601 | 1.015 | 6.664 | 0.371 |
ACTH ≧5 pg/mL | 0.038 | 2.759 | 1.060 | 7.185 | 0.428 |
ADH ≧30 pg/mL | 0.038 | 2.576 | 1.051 | 6.313 | 0.343 |
Factors | P- value | Odds ratio | 95% CI of odds ratio | Observed power | |
---|---|---|---|---|---|
Lower |
Upper | ||||
Age ≧50 yr | 0.008 | 3.217 | 1.348 | 7.680 | 0.770 |
ACTH ≧5 pg/mL | 0.054 | 2.265 | 0.987 | 5.198 | 0.499 |
ADH ≧30 pg/mL | 0.008 | 3.463 | 1.389 | 8.635 | 0.787 |
Factors | P- value | Odds ratio | 95% CI of odds ratio | Observed power | |
---|---|---|---|---|---|
Lower |
Upper | ||||
Age ≧50 yr | 0.001 | 4.564 | 1.794 | 11.612 | 0.914 |
ACTH ≧5 pg/mL | 0.110 | 2.125 | 0.843 | 5.356 | 0.346 |
ADH ≧30 pg/mL | 0.003 | 6.568 | 1.918 | 22.483 | 0.891 |
Discussion
Conclusions
Key messages
-
The axis of the hypothalamic-pituitary-adrenal gland was activated in patients with ROSC after cardiac arrest.
-
The patients with relative adrenal insufficiency, still higher ACTH and ADH had a poor outcome.