Resuscitation · 2026
Early Post-ROSC Laboratory Phenotypes and Clinical Outcomes after Out-of-Hospital Cardiac Arrest: A 10-Year National Cohort Study.
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Liu Xinyi, Chong Kwone Wai, Lau Yee How, Drum Chester Lee, Richards Arthur Mark, Lip Gregory Yh, Yeo Khung Keong, Ong Marcus Eh, Lim Shir Lynn, Singapore PAROS and SingCLOUD investigators
Аннотация
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.
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.