Early post-ROSC laboratory phenotypes and clinical outcomes after out-of-hospital cardiac arrest: a 10-year national cohort study.

IF 6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation Pub Date : 2026-10-09 DOI:10.1016/j.resuscitation.2026.111351

Xinyi Liu, Kwone Wai Chong, Yee How Lau, Chester Lee Drum, Arthur Mark Richards, Gregory Y H Lip, Khung Keong Yeo, Marcus E H Ong, Shir Lynn Lim

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引用次数: 0

Abstract

Background: Prior phenotyping in out-of-hospital cardiac arrest (OHCA) relied predominantly on prehospital indicators, which neither describe nor grade the underlying ischemia-reperfusion injury. We aimed to derive laboratory-based phenotypes and describe their clinical characteristics and outcome associations.

Methods: We conducted a retrospective cohort study of adult resuscitated OHCA patients of presumed cardiac etiology between 01/02/2011 and 01/01/2022, linking Singapore's national OHCA and cardiovascular databases. Unsupervised latent class analysis (LCA) was applied to 14 laboratory variables within six hours post-return of spontaneous circulation (ROSC). Stability was confirmed through split-sample validation. Logistic regression and Cox proportional hazards model, adjusted for age, sex and initial cardiac rhythm, assessed poor neurological recovery at hospital discharge, 30-day and 3-year mortality.

Results: Among 1514 eligible patients (median age 65.0 years, 73.6% males), LCA identified three distinct phenotypes: multi-organ dysfunction (MOD, N = 286), homeostatic (HOM, N = 967), and immune-dysregulated (IMD, N = 261), independently reproduced in derivation (entropy = 0.817) and replication (entropy = 0.892) subsamples. The most discriminative variables were creatinine, eosinophil and lymphocyte. Compared to MOD, both HOM (aOR: 0.50, 95% CI 0.30-0.78, p = 0.004) and IMD (aOR: 0.46, 95% CI 0.26-0.78, p = 0.005) phenotypes had significantly lower odds of poor neurological recovery. This pattern was consistent for 30-day mortality (HOM aHR: 0.71, 95% CI 0.61-0.83; IMD aHR: 0.78, 95% CI 0.64-0.94) and 3-year mortality (HOM aHR: 0.70, 95% CI 0.60-0.82; IMD aHR: 0.74, 95% CI 0.62-0.90), all p ≤ 0.01.

Conclusion: Early post-ROSC laboratory data identified three prognostically distinct phenotypes among resuscitated OHCA patients. These exploratory findings support external validation and investigation of phenotype-guided therapies.

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来源期刊

Resuscitation 医学-急救医学

CiteScore

12.00

自引率

18.50%

发文量

556

审稿时长

21 days

期刊介绍： Resuscitation is a monthly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training, clinical resuscitation, and experimental resuscitation research, although papers relating to animal studies will be published only if they are of exceptional interest and related directly to clinical cardiopulmonary resuscitation. Papers relating to trauma are published occasionally but the majority of these concern traumatic cardiac arrest.