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.	中国心脏骤停与心肺复苏报告编写组, 徐峰, 陈玉国. 中国心脏骤停与心肺复苏报告(2022 年版)概要. 中国循环杂志, 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.	Böttiger 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, 汪兴玲, 曾汇霞, 等. 脓毒症患者早期血小板减少对预后的预测价值. 江苏医药, 2022, 48(2): 123-126.
12.	朱振华, 段学姣, 张栋. 感染性休克患者血小板减少与重症监护病房内死亡的关系. 现代医药卫生, 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.	陈珵, 徐侃. 血小板在炎症反应中作用的研究进展. 海南医学, 2017, 28(4): 623-626.
18.	付阳, 张琦, 李梦雨, 等. 急性胰腺炎患者血小板相关参数与炎性指标的相关性研究. 华西医学, 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.	曹径实, 刘君钊, 叶胜, 等. 血小板-淋巴细胞比值联合序贯器官衰竭评分对院内心脏骤停患者短期预后的评估价值研究. 华西医学, 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.	邵昱铭, 刘伯夫, 曹钰, 等. 脂联素减轻心脏骤停后综合征小鼠脑损伤的机制研究. 西部医学, 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.	徐胜勇, 于学忠, 徐军. 胸外按压持续时间与心肺复苏结局关系研究. 临床急诊杂志, 2019, 20(8): 623-626, 631.
30.	王东晓, 李国贤, 李向阳, 等. 心脏骤停患者心肺复苏自主循环恢复预后相关因素分析. 岭南急诊医学杂志, 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. 中国心脏骤停与心肺复苏报告编写组, 徐峰, 陈玉国. 中国心脏骤停与心肺复苏报告(2022 年版)概要. 中国循环杂志, 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. Böttiger 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, 汪兴玲, 曾汇霞, 等. 脓毒症患者早期血小板减少对预后的预测价值. 江苏医药, 2022, 48(2): 123-126.
12. 朱振华, 段学姣, 张栋. 感染性休克患者血小板减少与重症监护病房内死亡的关系. 现代医药卫生, 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. 陈珵, 徐侃. 血小板在炎症反应中作用的研究进展. 海南医学, 2017, 28(4): 623-626.
18. 付阳, 张琦, 李梦雨, 等. 急性胰腺炎患者血小板相关参数与炎性指标的相关性研究. 华西医学, 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. 曹径实, 刘君钊, 叶胜, 等. 血小板-淋巴细胞比值联合序贯器官衰竭评分对院内心脏骤停患者短期预后的评估价值研究. 华西医学, 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. 邵昱铭, 刘伯夫, 曹钰, 等. 脂联素减轻心脏骤停后综合征小鼠脑损伤的机制研究. 西部医学, 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. 徐胜勇, 于学忠, 徐军. 胸外按压持续时间与心肺复苏结局关系研究. 临床急诊杂志, 2019, 20(8): 623-626, 631.
30. 王东晓, 李国贤, 李向阳, 等. 心脏骤停患者心肺复苏自主循环恢复预后相关因素分析. 岭南急诊医学杂志, 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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