Predicting Survival Outcomes in Post-Cardiac Arrest Syndrome: The Impact of Combined Sequential Organ Failure Assessment Score and Serum Lactate Measurement

Abstract

BACKGROUND Post-cardiac arrest syndrome (PCAS) is a major concern and shares pathophysiology with sepsis. Sequential organ failure assessment (SOFA) scores and serum lactate levels, as suggested in the Survival Sepsis Guidelines, have shown significant predictive value for prognosis in patients with sepsis. This retrospective study aimed to evaluate combined use of the SOFA score and serum lactate measurement on survival prognosis in PCAS. MATERIAL AND METHODS Our study included patients with return of spontaneous circulation after cardiac arrest who were age >18 years and underwent targeted temperature management. The 438 patients were allocated to a surviving group and a deceased group at discharge. Multivariable regression models were used to evaluate any association with SOFA scores, serum lactate levels, and survival. To evaluate the predictive value of regression models, the area under the receiver operating characteristic curve (AUROC) was assessed. RESULTS Lower SOFA score and serum lactate level were associated with better survival rates in the post-cardiac arrest patients (SOFA score: odds ratio (OR), 0.77; 95% confidence interval (CI), 0.67-0.88; P<0.001; lactate level: OR, 0.85; 95% CI, 0.81-0.94; P<0.001). The combined model of the SOFA score and serum lactate level was superior to models including either SOFA score or serum lactate level alone in predicting survival (AUROC, 0.86 vs 0.83, P=0.028, 0.86 vs 0.81, P=0.004). CONCLUSIONS Because of the superiority of the combined model of SOFA score and serum lactate level, combining these 2 factors could improve prediction of prognosis and survival outcomes in PCAS.