Predictive Value Of Pcv-aCO₂/Da-vO₂ Ratio To 7-day Survival Rate In Cardiac Arrest Patients With Post-resuscitation Syndrome

Objective:To explore the value of oxygen metabolism indexes on predicting the 7-day survival rate of patients with post-resuscitation syndrome,we analyzed the indexes of oxygen metabolism including Pcv-aCO₂/Da-vO₂,A-a DO₂,Pcv-aCO₂,Lac.Methods:This experiment was a retrospective study.The research objects were 45 patients with post-resuscitation syndrome form the ICU of Affiliated Hospital of Guilin Medical University and Donghua Hospital affiliated to Sun Yat-sen University during June 2018 to December 2019.The seventh day after the recovery of spontaneous circulation was set as the end point of the study.According to the survival status of the patients after 7 days,they were divided into survival group（n=20）and death group（n=25）,patients who were discharged automatically were excluded.Make diagnosis and treatment plan for patients according to guidelines for diagnosis and treatment of cardiac arrest.Offer routine life support to patients and treat primary diseases actively.The data of gender,age,APACHE II score and the number of injured organs were collected by searching medical records and nursing documents.Blood gas analysis was performed at T0,then calculate the ratio of A-a DO₂,Pcv-aCO₂ and Pcv-aCO₂/Da-vO₂ according to the formula,the relevant indexes are registered uniformly.The data were summarized and statistically analyzed,and the correlation between each predictive index and the survival rate of patients was compared.The ability of each index to predict the 7-day survival rate of patients with resuscitation syndrome was analyzed by the receiver operator characteristic curve（ROC）,and the predictive value of the combined index on the 7-day survival rate of patients with resuscitation syndrome was analyzed by combined test.Results:（1）The APACHE II score of the death group was higher than the survival group（P<0.05）.There was significant difference between the death group and the survival group.The ratio of A-a DO₂ and Pcv-aCO₂/Da-vO₂ in the death group were higher than those in the survival group（P<0.05）.There was no significant difference in age,sex,cumulative number of organs,Lac,ScvO₂ and Pcv-aCO₂ between two groups（P>0.05）.（2）Pcv-aCO₂/Da-vO₂ and APACHE II score were positively correlated with the poor prognosis of patients（P<0.05）,besides they are independent risk factors for poor prognosis（OR>1）,but A-a DO₂ is not an independent risk factor for poor prognosis（P>0.05）.（3）The AUROC of Pcv-aCO₂/Da-vO₂ ratio was 0.792（95%CI0.656-0.928）,which is better than other predictors.（4）The optimal cut off value of Pcv-aCO₂/Da-vO₂ ratio was 1.63（sensitivity:80.0%,specificity:75.0%,Yuden Index:0.55）,which is better than other predictors.（5）Series test（sensitivity:68.0%,specificity:95.0%,Youden Index:0.630）was superior to inparallel test（sensitivity:100.0%,specificity:40.0%,Youden Index:0.400）,when the Pcv-aCO₂/Da-vO₂ ratio and APACHE II score select1.63 and 14.5 respectively as the cut off value.Conclusions:（1）Pcv-aCO₂/Da-vO₂ could be a good predictive indicator for 7-day survival rate in patients with post-resuscitation syndrome,with sensitivity:80.0%,specificity:75.0%.（2）Series test of Pcv-aCO₂/Da-vO₂ ratio and APACHE II score can improve the predictive value of 7-day survival rate in patients with post-resuscitation syndrome.