Association between eGFR and neurological outcomes among patients with out‐of‐hospital cardiac arrest: A nationwide prospective study in Japan

Abstract

Abstract Aim We aimed to investigate the association between estimated glomerular filtration rate and prognosis in out‐of‐hospital cardiac arrest patients and explore the heterogeneity of the association. Methods Patients experiencing out‐of‐hospital cardiac arrest due to medical causes and registered in the JAAM‐OHCA Registry between June 2014 and December 2019 were stratified into shockable rhythm, pulseless electrical activity, and asystole groups according to the cardiac rhythm at the scene. The primary outcome was a 1‐month favorable neurological status. Adjusted odds ratios with 95% confidence intervals were calculated to investigate the association between estimated glomerular filtration rate and outcomes using a logistic model. Results Of the 19,443 patients included, 2769 had initial shockable rhythm at the scene, 5339 had pulseless electrical activity, and 11,335 had asystole. As the estimated glomerular filtration rate decreased, the adjusted odds ratio for a 1‐month favorable neurological status decreased among those with initial shockable rhythm (estimated glomerular filtration rate, adjusted odds ratio [95% CI]: 45–59 mL/min/1.73 m2, 0.61 [0.47–0.79]; 30–44 mL/min/1.73 m2, 0.45 [0.32–0.62]; 15–29 mL/min/1.73 m2, 0.35 [0.20–0.63]; and 65 years or patients with initial pulseless electrical activity or asystole. Conclusion The estimated glomerular filtration rate is associated with neurological prognosis in out‐of‐hospital cardiac arrest patients with initial shockable rhythm at the scene but not in those with initial non‐shockable rhythm.

Keywords

• cardiac rhythm
• comorbidity
• estimated glomerular filtration rate
• out‐of‐hospital cardiac arrest
• renal dysfunction