Association between prothrombin time-international normalized ratio and prognosis of post-cardiac arrest patients: A retrospective cohort study

Cardiac arrest (CA) can activate blood coagulation. This study aimed to explore the potential prognostic value of prothrombin time-international normalized ratio (INR) in post-CA patients. The clinical data of eligible subjects diagnosed with CA was extracted from the MIMIC-IV database as the traini...

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Published in:Frontiers in public health Vol. 11; p. 1112623
Main Authors: Tang, Yiyang, Sun, Jing, Yu, Zaixin, Liang, Benhui, Peng, Baohua, Ma, Jing, Zeng, Xiaofang, Feng, Yilu, Chen, Qin, Zha, Lihuang
Format: Journal Article
Language:English
Published: Switzerland Frontiers Media S.A 20.01.2023
Subjects:
all-cause mortality
cardiac arrest
critical care
Humans
International Normalized Ratio
MIMIC-IV database
Prognosis
Prothrombin Time
Public Health
Reproducibility of Results
Retrospective Studies
MIMIC-IV database
critical care
cardiac arrest
international normalized ratio
all-cause mortality
ISSN:2296-2565, 2296-2565
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Summary:Cardiac arrest (CA) can activate blood coagulation. This study aimed to explore the potential prognostic value of prothrombin time-international normalized ratio (INR) in post-CA patients. The clinical data of eligible subjects diagnosed with CA was extracted from the MIMIC-IV database as the training cohort. Restricted cubic spline (RCS), Kaplan-Meier (K-M) survival curve, and Cox regression analyses were conducted to elucidate the association between the INR and all-cause mortality of post-CA patients. Subgroup analysis, propensity score matching (PSM), and inverse probability of treatment (IPTW) were also conducted to improve stability and reliability. Data of the validation cohort were collected from the eICU database, and logistic-regression analyses were performed to verify the findings of the training cohort. A total of 1,324 subjects were included in the training cohort. A linear correlation existed between INR and the risk of all-cause death of post-CA patients, as shown in RCS analysis, with a hazard ratio (HR) >1 when INR exceeded 1.2. K-M survival curve preliminarily indicated that subjects with INR ≥ 1.2 presented lower survival rate and shorter survival time, and the high level of INR was independently associated with 30-day, 90-day, 1-year, and in-hospital mortalities, with multivariate-adjusted HR of 1.44 (1.20, 1.73), 1.46 (1.23, 1.74), 1.44 (1.23, 1.69), and 1.37 (1.14, 1.64), respectively. These findings were consistent and robust across the subgroup analysis, PSM and IPTW analyses, and validation cohort. We systematically and comprehensively demonstrated that elevated INR was associated with increased short- and long-term all-cause mortality of post-CA patients. Therefore, elevated INR may be a promising biomarker with prognosis significance.
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Reviewed by: Jose Luis Martin Conty, University of Castilla La Mancha, Spain; Miguel Ángel Castro Villamor, Facultad de Medicina, Universidad de Valladolid, Spain
These authors have contributed equally to this work
Edited by: Francisco Martín-Rodríguez, University of Valladolid, Spain
This article was submitted to Disaster and Emergency Medicine, a section of the journal Frontiers in Public Health
ISSN:2296-2565
2296-2565
DOI:10.3389/fpubh.2023.1112623