Association between oxidative stress index and post-CPR early mortality in cardiac arrest patients: A prospective observational study

Abstract

Objective: Cardiopulmonary resuscitation (CPR) is a series of lifesaving actions that improve the chance of survival following cardiac arrest (CA). Many clinical and laboratory parameters, such as the presence of asystole, out-of-hospital CPR, and duration of cardiac arrest, are associated with failed CPR in patients with CA. Asystole is a state of no cardiac electrical activity, along with the absence of contractions of the myocardium and absence of cardiac output. Oxidative stress index (OSI), which is the ratio of total oxidative status to total antioxidant status, increases by ischemia-reperfusion injury. We investigated whether OSI levels in patients with CA could predict early mortality after CPR. Methods: This study has a prospective observational cohort design. Five patients with a history of cancer, four patients who developed hemolysis in their blood, six patients who were transferred to our hospital from other hospitals, and six patients in whom blood samples for OSI could not be stored properly were excluded. Finally, a total of 90 in-hospital or out-of-hospital CA patients and 40 age-and sex-matched healthy volunteers as the control group were evaluated prospectively. The patients were classified according to the CPR response into a successful group (n=46) and a failed group (n=44). Comparisons between groups were performed using one-way ANOVA with post hoc analysis by Tukey's HSD or independent samples t-test and the Kruskal-Wallis tests or Mann-Whitney U test for normally and abnormally distributed data, respectively. Also, we used chi-square test, Spearman's correlation test, univariate and multible logistic regression analyses, and receiver operator characteristic curve analysis. Results: OSI was 3.0 +/- 4.0, 5.6 +/- 4.3, and 8.7 +/- 3.8 in the control group, the successful CPR group, and the failed CPR group, respectively (p<0.001 for the 2 comparisons). OSI on admission, ischemia-modified albumin, presence of asystole, mean duration of cardiac arrest, out-of-hospital CPR, pH, and potassium and sodium levels were found to have prognostic significance in the univariate analysis. In the multivariate logistic regression model, OSI on admission (OR=1.325, p=0.003), ischemia-modified albumin (OR=1.008, p=0.005), presence of asystole (OR=13.576, p<0.001), and sodium level (OR=1.132, p=0.029) remained associated with an increased risk of early mortality. In addition, the optimal cut-off value of OSI to predict post-CPR mortality was measured as >6.02, with 84.1% sensitivity and 76.1% specificity. Conclusion: Elevated OSI levels can predict failed CPR in CA patients.