title: Prognostic implication of initial coagulopathy in out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  We sought to investigate the prognostic implication of early coagulopathy represented by initial DIC score in out-of-hospital cardiac arrest (OHCA).
  
  
  METHODS
  OHCA registry was analyzed to identify patients with ROSC without recent use of anticoagulant between 2008 and 2011. Patients were assessed for prehosptial factors, initial laboratory results and therapeutic hypothermia. Outcome variables were survival discharge, 6-month CPC and survival duration within the first week after ROSC. Logistic regression and Cox proportional hazards models were used for both univariable and multivariable analysis.
  
  
  RESULTS
  Among 273 eligible patients, initial DIC score was available in 252 (92.3%). Higher DIC score was associated with increased inhospital death (odds ratio [OR], 1.89 per unit; 95% confidence interval [CI], 1.48-2.41) and unfavorable long-term outcome (6-month CPC 3-5; OR, 2.21 per unit; 95% CI, 1.60-3.05). The adjusted ORs for both outcomes were 1.61 (95% CI, 1.17-2.22) and 1.84 (95% CI, 1.26-2.67), respectively. We categorized DIC score in five groups as <3, 3, 4, 5 and >5 and analyzed differential mortality risk using Cox proportional hazards model. Compared with reference group (DIC score<3), the adjusted HR for early mortality in each remaining group was 1.96 (95% CI, 1.13-3.40), 2.26 (95% CI, 1.27-4.02), 2.77 (95% CI, 1.58-4.85) and 4.29 (95% CI, 2.22-8.30), respectively (p-trend<0.001). The area under the receiver operating characteristic of DIC score for prediction of unfavorable long-term outcome was 0.79 (95% CI, 0.69-0.88).
  
  
  CONCLUSIONS
  Increased initial DIC score in OHCA was an independent predictor for poor outcomes and early mortality risk.
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
authors.forename: Joonghee
authors.initials: J
authors.lastname: Kim
authors.forename: Kyuseok
authors.initials: K
authors.lastname: Kim
authors.forename: Jae Hyuk
authors.initials: JH
authors.lastname: Lee
authors.forename: You Hwan
authors.initials: YH
authors.lastname: Jo
authors.forename: Taeyun
authors.initials: T
authors.lastname: Kim
authors.forename: Joong Eui
authors.initials: JE
authors.lastname: Rhee
authors.forename: Kyeong Won
authors.initials: KW
authors.lastname: Kang
mesh_terms: D000368:Aged; D003627:Data Interpretation, Statistical; D004211:Disseminated Intravascular Coagulation / Q000209:etiology* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications* / Q000401:mortality*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate