Correlation between thrombocytopenia and short-term prognosis of patients with in-hospital cardiac arrest after spontaneous circulation recovery_West China Medical Journal

Authors：

GU Zhihan , LIU Bofu , YAO Peng , HE Yarong ,  CAO Yu

Department of Emergency Medicine, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CAO Yu, Email: yuyuer@126.com

Keywords：

In-hospital cardiac arrest; cardiopulmonary resuscitation; thrombocytopenia; poor prognosis

DOI：

10.7507/1002-0179.202308010

Video：

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Objective To investigate the relationship between thrombocytopenia after the restoration of spontaneous circulation and short-term prognosis of patients with in-hospital cardiac arrest. Methods The demographic data, post-resuscitation vital signs, post-resuscitation laboratory tests, and the 28-day mortality rate of patients who experienced in-hospital cardiac arrest at the Emergency Department of West China Hospital, Sichuan University between January 1st, 2016 and December 31st, 2016 were retrospectively analyzed. Logistic regression was used to analyze the correlation between thrombocytopenia after the return of spontaneous circulation and the 28-day mortality rate in these cardiac arrest patients. Results Among the 285 patients included, compared with the normal platelet group (n=130), the thrombocytopenia group (n=155) showed statistically significant differences in red blood cell count, hematocrit, white blood cell count, prothrombin time, activated partial thromboplastin time, and international normalized ratio (P<0.05). The 28-day mortality rate was higher in the thrombocytopenia group than that in the normal platelet group (84.5% vs. 71.5%, P=0.008). Multiple logistic regression analysis indicated that thrombocytopenia [odds ratio =2.260, 95% confidence interval (1.153, 4.429), P=0.018] and cardiopulmonary resuscitation duration [odds ratio=1.117, 95% confidence interval (1.060, 1.177), P<0.001] were independent risk factors for 28-day mortality in patients with in-hospital cardiac arrest. Conclusion Thrombocytopenia after restoration of spontaneous circulation is associated with poor short-term prognosis in patients with in-hospital cardiac arrest.

Citation： GU Zhihan, LIU Bofu, YAO Peng, HE Yarong, CAO Yu. Correlation between thrombocytopenia and short-term prognosis of patients with in-hospital cardiac arrest after spontaneous circulation recovery. West China Medical Journal, 2024, 39(8): 1219-1224. doi: 10.7507/1002-0179.202308010 Copy

1.	中國心臟驟停與心肺復蘇報告編寫組, 徐峰, 陳玉國. 中國心臟驟停與心肺復蘇報告(2022 年版)概要. 中國循環雜志, 2023, 38(10): 1005-1017.
2.	Thai TN, Ebell MH. Prospective validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score for in-hospital cardiac arrest prognosis. Resuscitation, 2019, 140: 2-8.
3.	D’Arrigo S, Cacciola S, Dennis M, et al. Predictors of favourable outcome after in-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis. Resuscitation, 2017, 121: 62-70.
4.	Radeschi G, Mina A, Berta G, et al. Incidence and outcome of in-hospital cardiac arrest in Italy: a multicentre observational study in the Piedmont Region. Resuscitation, 2017, 119: 48-55.
5.	Gando S, Wada T. Disseminated intravascular coagulation in cardiac arrest and resuscitation. J Thromb Haemost, 2019, 17(8): 1205-1216.
6.	Kim HJ, Park KN, Kim SH, et al. Time course of platelet counts in relation to the neurologic outcome in patients undergoing targeted temperature management after cardiac arrest. Resuscitation, 2019, 140: 113-119.
7.	B?ttiger BW, Martin E. Thrombolytic therapy during cardiopulmonary resuscitation and the role of coagulation activation after cardiac arrest. Curr Opin Crit Care, 2001, 7(3): 176-183.
8.	Liu Y, Sun W, Guo Y, et al. Association between platelet parameters and mortality in coronavirus disease 2019: retrospective cohort study. Platelets, 2020, 31(4): 490-496.
9.	Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol, 2020, 7(9): e671-e678.
10.	Péju E, Fouqué G, Charpentier J, et al. Clinical significance of thrombocytopenia in patients with septic shock: an observational retrospective study. J Crit Care, 2023, 76: 154293.
11.	潘朝勇, 汪興玲, 曾匯霞, 等. 膿毒癥患者早期血小板減少對預后的預測價值. 江蘇醫藥, 2022, 48(2): 123-126.
12.	朱振華, 段學姣, 張棟. 感染性休克患者血小板減少與重癥監護病房內死亡的關系. 現代醫藥衛生, 2021, 37(22): 3823-3827.
13.	Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation, 2017, 135(10): e146-e603.
14.	Levi M, Ten Cate H. Disseminated intravascular coagulation. N Engl J Med, 1999, 341(8): 586-592.
15.	Levi M, Schultz M, van der Poll T. Sepsis and thrombosis. Semin Thromb Hemost, 2013, 39(5): 559-566.
16.	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 2016, 315(8): 801-810.
17.	陳珵, 徐侃. 血小板在炎癥反應中作用的研究進展. 海南醫學, 2017, 28(4): 623-626.
18.	付陽, 張琦, 李夢雨, 等. 急性胰腺炎患者血小板相關參數與炎性指標的相關性研究. 華西醫學, 2020, 35(8): 943-947.
19.	Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest, 1992, 101(6): 1644-1655.
20.	Smyth SS, McEver RP, Weyrich AS, et al. Platelet functions beyond hemostasis. J Thromb Haemost, 2009, 7(11): 1759-1766.
21.	曹徑實, 劉君釗, 葉勝, 等. 血小板-淋巴細胞比值聯合序貫器官衰竭評分對院內心臟驟停患者短期預后的評估價值研究. 華西醫學, 2020, 35(9): 1068-1073.
22.	Zhang S, Cui YL, Diao MY, et al. Use of platelet indices for determining illness severity and predicting prognosis in critically ill patients. Chin Med J (Engl), 2015, 128(15): 2012-2018.
23.	Claushuis TA, van Vught LA, Scicluna BP, et al. Thrombocytopenia is associated with a dysregulated host response in critically ill sepsis patients. Blood, 2016, 127(24): 3062-3072.
24.	Thiery-Antier N, Binquet C, Vinault S, et al. Is thrombocytopenia an early prognostic marker in septic shock?. Crit Care Med, 2016, 44(4): 764-772.
25.	邵昱銘, 劉伯夫, 曹鈺, 等. 脂聯素減輕心臟驟停后綜合征小鼠腦損傷的機制研究. 西部醫學, 2016, 28(12): 1632-1637.
26.	Neumar RW, Nolan JP, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation, 2008, 118(23): 2452-2483.
27.	Bro-Jeppesen J, Kjaergaard J, Wanscher M, et al. Systemic inflammatory response and potential prognostic implications after out-of-hospital cardiac arrest: a substudy of the target temperature management trial. Crit Care Med, 2015, 43(6): 1223-1232.
28.	Boulaftali Y, Hess PR, Getz TM, et al. Platelet ITAM signaling is critical for vascular integrity in inflammation. J Clin Invest, 2013, 123(2): 908-916.
29.	徐勝勇, 于學忠, 徐軍. 胸外按壓持續時間與心肺復蘇結局關系研究. 臨床急診雜志, 2019, 20(8): 623-626, 631.
30.	王東曉, 李國賢, 李向陽, 等. 心臟驟停患者心肺復蘇自主循環恢復預后相關因素分析. 嶺南急診醫學雜志, 2022, 27(6): 506-509.
31.	Matsuyama T, Ohta B, Kiyohara K, et al. Cardiopulmonary resuscitation duration and favorable neurological outcome after out-of-hospital cardiac arrest: a nationwide multicenter observational study in Japan (the JAAM-OHCA registry). Crit Care, 2022, 26(1): 120.
32.	Coppler PJ, Elmer J, Doshi AA, et al. Duration of cardiopulmonary resuscitation and phenotype of post-cardiac arrest brain injury. Resuscitation, 2023, 188: 109823.

1. 中國心臟驟停與心肺復蘇報告編寫組, 徐峰, 陳玉國. 中國心臟驟停與心肺復蘇報告(2022 年版)概要. 中國循環雜志, 2023, 38(10): 1005-1017.
2. Thai TN, Ebell MH. Prospective validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score for in-hospital cardiac arrest prognosis. Resuscitation, 2019, 140: 2-8.
3. D’Arrigo S, Cacciola S, Dennis M, et al. Predictors of favourable outcome after in-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis. Resuscitation, 2017, 121: 62-70.
4. Radeschi G, Mina A, Berta G, et al. Incidence and outcome of in-hospital cardiac arrest in Italy: a multicentre observational study in the Piedmont Region. Resuscitation, 2017, 119: 48-55.
5. Gando S, Wada T. Disseminated intravascular coagulation in cardiac arrest and resuscitation. J Thromb Haemost, 2019, 17(8): 1205-1216.
6. Kim HJ, Park KN, Kim SH, et al. Time course of platelet counts in relation to the neurologic outcome in patients undergoing targeted temperature management after cardiac arrest. Resuscitation, 2019, 140: 113-119.
7. B?ttiger BW, Martin E. Thrombolytic therapy during cardiopulmonary resuscitation and the role of coagulation activation after cardiac arrest. Curr Opin Crit Care, 2001, 7(3): 176-183.
8. Liu Y, Sun W, Guo Y, et al. Association between platelet parameters and mortality in coronavirus disease 2019: retrospective cohort study. Platelets, 2020, 31(4): 490-496.
9. Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol, 2020, 7(9): e671-e678.
10. Péju E, Fouqué G, Charpentier J, et al. Clinical significance of thrombocytopenia in patients with septic shock: an observational retrospective study. J Crit Care, 2023, 76: 154293.
11. 潘朝勇, 汪興玲, 曾匯霞, 等. 膿毒癥患者早期血小板減少對預后的預測價值. 江蘇醫藥, 2022, 48(2): 123-126.
12. 朱振華, 段學姣, 張棟. 感染性休克患者血小板減少與重癥監護病房內死亡的關系. 現代醫藥衛生, 2021, 37(22): 3823-3827.
13. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation, 2017, 135(10): e146-e603.
14. Levi M, Ten Cate H. Disseminated intravascular coagulation. N Engl J Med, 1999, 341(8): 586-592.
15. Levi M, Schultz M, van der Poll T. Sepsis and thrombosis. Semin Thromb Hemost, 2013, 39(5): 559-566.
16. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 2016, 315(8): 801-810.
17. 陳珵, 徐侃. 血小板在炎癥反應中作用的研究進展. 海南醫學, 2017, 28(4): 623-626.
18. 付陽, 張琦, 李夢雨, 等. 急性胰腺炎患者血小板相關參數與炎性指標的相關性研究. 華西醫學, 2020, 35(8): 943-947.
19. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest, 1992, 101(6): 1644-1655.
20. Smyth SS, McEver RP, Weyrich AS, et al. Platelet functions beyond hemostasis. J Thromb Haemost, 2009, 7(11): 1759-1766.
21. 曹徑實, 劉君釗, 葉勝, 等. 血小板-淋巴細胞比值聯合序貫器官衰竭評分對院內心臟驟停患者短期預后的評估價值研究. 華西醫學, 2020, 35(9): 1068-1073.
22. Zhang S, Cui YL, Diao MY, et al. Use of platelet indices for determining illness severity and predicting prognosis in critically ill patients. Chin Med J (Engl), 2015, 128(15): 2012-2018.
23. Claushuis TA, van Vught LA, Scicluna BP, et al. Thrombocytopenia is associated with a dysregulated host response in critically ill sepsis patients. Blood, 2016, 127(24): 3062-3072.
24. Thiery-Antier N, Binquet C, Vinault S, et al. Is thrombocytopenia an early prognostic marker in septic shock?. Crit Care Med, 2016, 44(4): 764-772.
25. 邵昱銘, 劉伯夫, 曹鈺, 等. 脂聯素減輕心臟驟停后綜合征小鼠腦損傷的機制研究. 西部醫學, 2016, 28(12): 1632-1637.
26. Neumar RW, Nolan JP, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation, 2008, 118(23): 2452-2483.
27. Bro-Jeppesen J, Kjaergaard J, Wanscher M, et al. Systemic inflammatory response and potential prognostic implications after out-of-hospital cardiac arrest: a substudy of the target temperature management trial. Crit Care Med, 2015, 43(6): 1223-1232.
28. Boulaftali Y, Hess PR, Getz TM, et al. Platelet ITAM signaling is critical for vascular integrity in inflammation. J Clin Invest, 2013, 123(2): 908-916.
29. 徐勝勇, 于學忠, 徐軍. 胸外按壓持續時間與心肺復蘇結局關系研究. 臨床急診雜志, 2019, 20(8): 623-626, 631.
30. 王東曉, 李國賢, 李向陽, 等. 心臟驟停患者心肺復蘇自主循環恢復預后相關因素分析. 嶺南急診醫學雜志, 2022, 27(6): 506-509.
31. Matsuyama T, Ohta B, Kiyohara K, et al. Cardiopulmonary resuscitation duration and favorable neurological outcome after out-of-hospital cardiac arrest: a nationwide multicenter observational study in Japan (the JAAM-OHCA registry). Crit Care, 2022, 26(1): 120.
32. Coppler PJ, Elmer J, Doshi AA, et al. Duration of cardiopulmonary resuscitation and phenotype of post-cardiac arrest brain injury. Resuscitation, 2023, 188: 109823.

West China Medical Journal

Correlation between thrombocytopenia and short-term prognosis of patients with in-hospital cardiac arrest after spontaneous circulation recovery

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