Fibrin/fibrinogen degradation products (FDP) at hospital admission predict neurological outcomes in out-of-hospital cardiac arrest patients

Yuichi Ono; Mineji Hayakawa; Kunihiko Maekawa; Akira Kodate; Yoshihiro Sadamoto; Naoki Tominaga; Hiromoto Murakami; Tomonao Yoshida; Kenichi Katabami; Takeshi Wada; Hisako Sageshima; Atsushi Sawamura; Satoshi Gando

doi:10.1016/j.resuscitation.2016.11.017

Fibrin/fibrinogen degradation products (FDP) at hospital admission predict neurological outcomes in out-of-hospital cardiac arrest patients

Resuscitation. 2017 Feb:111:62-67. doi: 10.1016/j.resuscitation.2016.11.017. Epub 2016 Dec 6.

Affiliations

¹ Hokkaido University, Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan. Electronic address: rjtkk3299@yahoo.co.jp.
² Hokkaido University, Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.

PMID: 27940211
DOI: 10.1016/j.resuscitation.2016.11.017

Abstract

Objective: This study aimed to test the hypothesis that coagulation, fibrinolytic markers and disseminated intravascular coagulation (DIC) score (International Society on Thrombosis and Haemostasis) at hospital admission of out-of-hospital cardiac arrest (OHCA) patients can predict neurological outcomes 1 month after cardiac arrest.

Methods: In this retrospective, observational analysis, data were collected from the Sapporo Utstein Registry and medical records at Hokkaido University Hospital. We included patients who experienced OHCA with successful return of spontaneous circulation (ROSC) between 2006 and 2012 and were transferred to Hokkaido University Hospital. From medical records, we collected information about the following coagulation and fibrinolytic factors at hospital admission: platelet count; prothrombin time; activated partial thromboplastin time; plasma levels of fibrinogen, D-dimer, fibrin/fibrinogen degradation products (FDP), and antithrombin; and calculated DIC score. Favorable neurological outcomes were defined as a cerebral performance category 1-2.

Results: We analyzed data for 315 patients. Except for fibrinogen level, all coagulation variables, fibrinolytic variables, and DIC score were associated with favorable neurological outcomes. In the receiver operating characteristic curve analysis, FDP level had the largest area under the curve (AUC; 0.795). In addition, the AUC of FDP level was larger than that of lactate level.

Conclusions: All of the coagulation and fibrinolytic markers, except for fibrinogen level, and DIC score at hospital admission, were associated with favorable neurological outcomes. Of all of the variables, FDP level was most closely associated with favorable neurological outcomes in OHCA patients who successfully achieved ROSC.

Keywords: Cardiopulmonary resuscitation; Neurological outcome; Out-of-hospital cardiac arrest.

MeSH terms

Aged
Disseminated Intravascular Coagulation / etiology
Disseminated Intravascular Coagulation / therapy
Female
Fibrin Fibrinogen Degradation Products / therapeutic use*
Forecasting
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / complications
Out-of-Hospital Cardiac Arrest / therapy*
Patient Admission
Prognosis
ROC Curve
Retrospective Studies

Substances

Fibrin Fibrinogen Degradation Products