Trajectories of Vital Signs and Risk of In-Hospital Cardiac Arrest

Frontiers in Medicine

Cheng-Chung Fang¹  Chu-Lin Tsai¹  Chien-Hua Huang¹  Tsung-Chien Lu¹  Chih-Hung Wang¹  Wen-Jone Chen¹ 

[1] Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan;Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan;

关键词: cardiac arrest;    vital sign;    group-based trajectory modeling;    in-hospital cardiac arrest;    longitudinal modeling;    emergency department (ED);   

DOI  :  10.3389/fmed.2021.800943

来源: DOAJ

【 摘 要 】

Background: Little is known about the trajectories of vital signs prior to in-hospital cardiac arrest (IHCA), which could explain the heterogeneous processes preceding this event. We aimed to identify clinically relevant subphenotypes at high risk of IHCA in the emergency department (ED).Methods: This retrospective cohort study used electronic clinical warehouse data from a tertiary medical center. We retrieved data from 733,398 ED visits over a 7-year period. We selected one ED visit per person and retrieved patient demographics, triage data, vital signs (systolic blood pressure [SBP], heart rate [HR], body temperature, respiratory rate, oxygen saturation), selected laboratory markers, and IHCA status. Group-based trajectory modeling was performed.Results: There were 37,697 adult ED patients with a total of 1,507,121 data points across all vital-sign categories. Three to four trajectory groups per vital-sign category were identified, and the following five trajectory groups were associated with a higher rate of IHCA: low and fluctuating SBP, high and fluctuating HR, persistent hypothermia, recurring tachypnea, and low and fluctuating oxygen saturation. The IHCA-prone trajectory group was associated with a higher triage level and a higher mortality rate, compared to other trajectory groups. Except for the persistent hypothermia group, the other four trajectory groups were more likely to have higher levels of C-reactive protein, lactic acid, cardiac troponin I, and D-dimer. Multivariable analysis revealed that hypothermia (adjusted odds ratio [aOR], 2.20; 95% confidence interval [95%CI], 1.35–3.57) and recurring tachypnea (aOR 2.44; 95%CI, 1.24–4.79) were independently associated with IHCA.Conclusions: We identified five novel vital-sign sub-phenotypes associated with a higher likelihood of IHCA, with distinct patterns in clinical course and laboratory markers. A better understanding of the pre-IHCA vital-sign trajectories may help with the early identification of deteriorating patients.

【 授权许可】

Unknown