The Relation between Coagulation Profile Test and Outcome in Survivors who were Treated with Therapeutic Hypothermia after Cardiopulmonary Resuscitation

ABSTRACT

PURPOSE: The purpose of this study is to clarify the clinical significance of coagulation factor as a prognostic tool in patients with cardiac arrest treated with therapeutic hypothermia (TH). METHODS: We designed a retrospective case review study in one university hospital. All adult patients who suffered cardiac arrest from December 2011 to February 2014 were considered for inclusion in the study. Patients who did not undergo TH were excluded from the analysis. Patients with any hematologic disorder were also excluded. Patients were divided into two groups, the good outcome group and the poor outcome group depending on the final cerebral performance category (CPC). Serum D-dimer, FDP, PT, aPTT, anti-thrombin III, fibrinogen, Troponin T, CK-MB, Troponin-I, DIC score, NSE, and S-100 were taken within one hour after ROSC. Logistic regression was used for multivariable analysis. RESULTS: A total of 92 patients were included; 22 in the good outcome group, 70 in the poor outcome group. The median serum PT, aPTT, FDP, fibrinogen, and D-dimer levels were grossly elevated in the poor outcome group. Only serum PT, D-dimer level showed significant association with poor outcome (PT OR=1.577; 95% CI=1.08-17.49, D-dimer OR=1.577; 95% CI=1.06-2.33). The area under the receiver operating characteristic (AUC) of PT, D-dimer, and S-100 for prediction of poor outcome was 0.822 (95% CI=0.72-0.89), 0.68 (95% CI=0.57-0.77), and 0.811 (95% CI=0.70-0.89), respectively. Other factors were not associated with prognosis. CONCLUSION: Increased PT and D-dimer levels are significantly associated with poor outcome. PT and D-dimer values have potential for use as new prognostic predictors along with the current prognostic factor, S-100 protein.