The neuro-prognostic value of the ion shift index in cardiac arrest patients following extracorporeal cardiopulmonary resuscitation

doi:10.5847/wjem.j.1920-8642.2023.087

Abstract

Abstract:

BACKGROUND: The ion shift index (ISI) as a prognostic indicator that can show the severity of hypoxic-ischemic injury. We aimed to evaluate the performance of the ISI in predicting unfavorable neurological outcomes at hospital discharge in cardiac arrest (CA) patients following extracorporeal cardiopulmonary resuscitation (ECPR) and to compare its performance to other prognostic predictors.
METHODS: This was a retrospective observational study including adult CA patients treated with ECPR between January 2018 and December 2022 in a tertiary hospital. Data regarding clinical characteristics and laboratory parameters were collected from medical records. The ISI was determined based on the first available serum electrolyte levels after ECPR. The primary outcome was unfavorable neurological status at hospital discharge, defined as Cerebral Performance Categories 3-5. Comparisons of the characteristics between the two groups were made using the χ² test for categorical variables and the t-test or non-parametric Mann-Whitney U-test for continuous variables, as appropriate. Correlation analysis was performed using Spearman’s rank correlation coefficient. A two-tailed P-value <0.05 was considered statistically significant.
RESULTS: Among the 122 patients involved, 46 (37.7%) had out-of-hospital CA, and 88 had unfavorable neurological outcomes. The ISI was significantly higher in the unfavorable outcome group than in the favorable outcome group (3.74 [3.15-4.57] vs. 2.69 [2.51-3.07], P<0.001). A higher ISI level was independently related to unfavorable outcome (odds ratio=6.529, 95% confidence interval 2.239-19.044, P=0.001). An ISI level >3.12 predicted unfavorable outcomes with a sensitivity and specificity of 74.6% and 85.2%, respectively (P<0.001). The prognostic performance of ISI (area under the curve [AUC]=0.887) was similar to that of other predictors, such as gray-to-white matter ratio (AUC=0.850, P=0.433) and neuron-specific enolase (AUC=0.925, P=0.394).
CONCLUSION: ISI may be used as a prognostic biomarker to predict neurological outcomes in CA patients following ECPR.

Key words: Cardiac arrest, Ion shift index, Extracorporeal cardiopulmonary resuscitation

Gannan Wang, Zhe Wang, Yi Zhu, Zhongman Zhang, Wei Li, Xufeng Chen, Yong Mei. The neuro-prognostic value of the ion shift index in cardiac arrest patients following extracorporeal cardiopulmonary resuscitation[J]. World Journal of Emergency Medicine, 2023, 14(5): 354-359.

Figures/Tables 4

Figure 1.

Table 1.

Clinical and laboratory characteristics of enrolled patients

Characteristics	Favorable neurological outcome (n=34)	Unfavorable neurological outcome (n=88)	t/χ²/Z	P-value
Age, years, mean±SD	52.35±14.76	49.28±17.02	0.925	0.357
Male, n (%)	22 (64.7)	67 (76.1)	1.624	0.203
Comorbidities, n (%)
Hypertension	14 (41.2)	30 (34.1)	0.534	0.465
Diabetes	8 (23.5)	17 (19.3)	0.267	0.605
Coronary artery disease	2 (5.9)	8 (9.1)	0.045	0.833
OHCA, n (%)	7 (20.6)	39 (44.3)	5.880	0.015
Witnessed, n (%)	34 (100)	80 (90.9)	1.991	0.158
Bystander CPR, n (%)	34 (100)	73 (83.0)	5.122	0.024
Cardiac etiology, n (%)	27 (79.4)	68 (77.3)	0.065	0.799
Initial non-shockable rhythm, n (%)	23 (67.6)	44 (50.0)	3.085	0.079
Resuscitation duration, min, median (IQR)	40.5 (17.5-55.0)	50.0 (34.0-82.3)	-2.639	0.008
ECMO duration, h, median (IQR)	141.5 (122.8-187.8)	94.4 (49.3-169.3)	-3.278	0.001
Length of stay in hospital, d, median (IQR)	19 (15-27)	5 (3-11)	-6.609	<0.001
GCS score after ECPR, median (IQR)	9 (8-12)	3 (3-4)	-7.765	<0.001
Prognostic predictors
GCS-M ≤2, n (%)	5 (14.7)	81 (92.0)	70.522	<0.001
Pupillary/corneal reflex absence, n (%)	0 (0)	51 (58.0)	33.859	<0.001
GWR-basal ganglia, median (IQR)	1.25 (1.20-1.27)	1.14 (1.08-1.19)	-5.977	<0.001
NSE, ng/mL, median (IQR)	44.6 (38.3-60.7)	188.5 (88.1-370.0)	-6.972	<0.001
Laboratory parameters, median (IQR)
Hemoglobin, g/L	116.5 (101.0-132.3)	111.0 (84.0-129.0)	-1.385	0.166
pH	7.41 (7.31-7.52)	7.22 (6.96-7.36)	-4.046	<0.001
Lactate, mmol/L	3.1 (1.1-11.5)	10.2 (4.0-15.6)	-2.854	0.004
Glucose, mmol/L	9.5 (6.7-11.7)	10.1 (7.1-13.5)	-0.504	0.614
Albumin, g/L	33.8 (30.3-39.3)	31.8 (26.5-39.2)	-1.008	0.313
ALT, U/L	159.0 (102.1-309.6)	306.1 (120.5-801.5)	-2.438	0.015
Aspartate aminotransferase, U/L	420.3 (170.1-932.0)	926.7 (364.6-2176.5)	-2.889	0.004
Total bilirubin, μmol/L	14.0 (10.8-19.9)	20.1 (13.1-32.2)	-2.204	0.028
Creatinine, μmol/L	96.1 (69.0-137.7)	76.5 (103.2-148.2)	-1.074	0.283
Potassium, mmol/L	3.9 (3.6-4.3)	4.5 (3.8-5.2)	-3.489	<0.001
Magnesium, mmol/L	0.9 (0.8-1.0)	1.0 (0.9-1.1)	-1.994	0.046
Phosphate, mmol/L	1.0 (0.7-1.2)	1.2 (0.8-2.1)	-2.778	0.005
Calcium, mmol/L	2.1 (2.0-2.2)	1.9 (1.6-2.1)	-3.907	<0.001
Ion shift index	2.69 (2.51-3.07)	3.74 (3.15-4.57)	-6.504	<0.001

Table 1.

Table 2.

Figure 2.

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Parameters	Coefficient	OR	95% CI	P-value
Initial non-shockable rhythm	1.581	4.862	1.249-18.927	0.023
ALT, U/L	0.002	1.002	0.999-1.005	0.065
pH	8.986	0.001	0.001-0.036	0.002
Lactate, mmol/L	0.155	1.168	0.990-1.378	0.066
Ion shift index	1.876	6.529	2.239-19.044	0.001

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