External Validation of 3 Prediction Models for Mortality in Out‐of‐Hospital Cardiac Arrest Survivors: A Retrospective Multicenter Study
Background Predictive models such as the Cardiac Arrest Survival Score (CASS), FACTOR score, and Survival After ROSC in Cardiac Arrest (SARICA) have been developed to estimate in‐hospital mortality in out‐of‐hospital cardiac arrest survivors. This study aims to externally validate and compare their...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-08-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.125.042033 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849233342417862656 |
|---|---|
| author | Chun‐Hsiang Huang Edward Pei‐Chuan Huang Cheng‐Yi Fan Yi‐Chien Kuo Chien‐Tai Huang Ching‐Yu Chen Chi‐Hsin Chen Yi‐Ju Ho Chun‐Ju Lien Yun‐Chang Chen Sih‐Shiang Huang Tzu‐Hsueh Wang Wen‐Chu Chiang Wei‐Tien Chang Chien‐Hua Huang Chih‐Wei Sung |
| author_facet | Chun‐Hsiang Huang Edward Pei‐Chuan Huang Cheng‐Yi Fan Yi‐Chien Kuo Chien‐Tai Huang Ching‐Yu Chen Chi‐Hsin Chen Yi‐Ju Ho Chun‐Ju Lien Yun‐Chang Chen Sih‐Shiang Huang Tzu‐Hsueh Wang Wen‐Chu Chiang Wei‐Tien Chang Chien‐Hua Huang Chih‐Wei Sung |
| author_sort | Chun‐Hsiang Huang |
| collection | DOAJ |
| description | Background Predictive models such as the Cardiac Arrest Survival Score (CASS), FACTOR score, and Survival After ROSC in Cardiac Arrest (SARICA) have been developed to estimate in‐hospital mortality in out‐of‐hospital cardiac arrest survivors. This study aims to externally validate and compare their predictive performance to determine their clinical utility upon emergency department admission. Methods This retrospective multicenter cohort study included out‐of‐hospital cardiac arrest patients admitted to the National Taiwan University Hospital and its branches between January 2016 and March 2024. The outcome was in‐hospital mortality following intensive care unit admission. We assessed the CASS, FACTOR, and a modified SARICA (mSARICA) score using the area under the receiver operating characteristic curve, positive predictive value, and negative predictive value. The SARICA score was adapted into the mSARICA score to ensure outcome consistency. The positive predictive value threshold was set at 0.85 to minimize false‐positive predictions. Results The study included 1456 patients, of whom 495 (34%) survived to discharge and 961 (66%) died before discharge. The area under the receiver operating characteristics for CASS, FACTOR, and mSARICA were 0.684 (95% CI, 0.654–0.713), 0.677 (95% CI, 0.647–0.706), and 0.711 (95% CI, 0.682–0.739), respectively, with no significant differences among them. The optimal cutoff values were >17.5 for CASS, ≥69.25 for FACTOR, and <1.0 for mSARICA. While CASS and FACTOR demonstrated similar sensitivity, specificity, and negative predictive value, mSARICA exhibited significantly higher sensitivity, lower specificity, and higher negative predictive value. Conclusions All scores demonstrated fair but not excellent discrimination for in‐hospital mortality. When minimizing false positives is critical, CASS and FACTOR may be preferable, whereas mSARICA offers greater sensitivity. |
| format | Article |
| id | doaj-art-a3e520d1a2cc4bd8bb43aaaeeb993513 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-a3e520d1a2cc4bd8bb43aaaeeb9935132025-08-20T07:25:01ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-08-01141610.1161/JAHA.125.042033External Validation of 3 Prediction Models for Mortality in Out‐of‐Hospital Cardiac Arrest Survivors: A Retrospective Multicenter StudyChun‐Hsiang Huang0Edward Pei‐Chuan Huang1Cheng‐Yi Fan2Yi‐Chien Kuo3Chien‐Tai Huang4Ching‐Yu Chen5Chi‐Hsin Chen6Yi‐Ju Ho7Chun‐Ju Lien8Yun‐Chang Chen9Sih‐Shiang Huang10Tzu‐Hsueh Wang11Wen‐Chu Chiang12Wei‐Tien Chang13Chien‐Hua Huang14Chih‐Wei Sung15Department of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Yun‐Lin Branch Yunlin TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Taipei TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Yun‐Lin Branch Yunlin TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanDepartment of Emergency Medicine, College of Medicine National Taiwan University Taipei TaiwanDepartment of Emergency Medicine, College of Medicine National Taiwan University Taipei TaiwanDepartment of Emergency Medicine, College of Medicine National Taiwan University Taipei TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanBackground Predictive models such as the Cardiac Arrest Survival Score (CASS), FACTOR score, and Survival After ROSC in Cardiac Arrest (SARICA) have been developed to estimate in‐hospital mortality in out‐of‐hospital cardiac arrest survivors. This study aims to externally validate and compare their predictive performance to determine their clinical utility upon emergency department admission. Methods This retrospective multicenter cohort study included out‐of‐hospital cardiac arrest patients admitted to the National Taiwan University Hospital and its branches between January 2016 and March 2024. The outcome was in‐hospital mortality following intensive care unit admission. We assessed the CASS, FACTOR, and a modified SARICA (mSARICA) score using the area under the receiver operating characteristic curve, positive predictive value, and negative predictive value. The SARICA score was adapted into the mSARICA score to ensure outcome consistency. The positive predictive value threshold was set at 0.85 to minimize false‐positive predictions. Results The study included 1456 patients, of whom 495 (34%) survived to discharge and 961 (66%) died before discharge. The area under the receiver operating characteristics for CASS, FACTOR, and mSARICA were 0.684 (95% CI, 0.654–0.713), 0.677 (95% CI, 0.647–0.706), and 0.711 (95% CI, 0.682–0.739), respectively, with no significant differences among them. The optimal cutoff values were >17.5 for CASS, ≥69.25 for FACTOR, and <1.0 for mSARICA. While CASS and FACTOR demonstrated similar sensitivity, specificity, and negative predictive value, mSARICA exhibited significantly higher sensitivity, lower specificity, and higher negative predictive value. Conclusions All scores demonstrated fair but not excellent discrimination for in‐hospital mortality. When minimizing false positives is critical, CASS and FACTOR may be preferable, whereas mSARICA offers greater sensitivity.https://www.ahajournals.org/doi/10.1161/JAHA.125.042033external validationin‐hospital mortalityout‐of‐hospital cardiac arrestpredictive modelsrisk stratification |
| spellingShingle | Chun‐Hsiang Huang Edward Pei‐Chuan Huang Cheng‐Yi Fan Yi‐Chien Kuo Chien‐Tai Huang Ching‐Yu Chen Chi‐Hsin Chen Yi‐Ju Ho Chun‐Ju Lien Yun‐Chang Chen Sih‐Shiang Huang Tzu‐Hsueh Wang Wen‐Chu Chiang Wei‐Tien Chang Chien‐Hua Huang Chih‐Wei Sung External Validation of 3 Prediction Models for Mortality in Out‐of‐Hospital Cardiac Arrest Survivors: A Retrospective Multicenter Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease external validation in‐hospital mortality out‐of‐hospital cardiac arrest predictive models risk stratification |
| title | External Validation of 3 Prediction Models for Mortality in Out‐of‐Hospital Cardiac Arrest Survivors: A Retrospective Multicenter Study |
| title_full | External Validation of 3 Prediction Models for Mortality in Out‐of‐Hospital Cardiac Arrest Survivors: A Retrospective Multicenter Study |
| title_fullStr | External Validation of 3 Prediction Models for Mortality in Out‐of‐Hospital Cardiac Arrest Survivors: A Retrospective Multicenter Study |
| title_full_unstemmed | External Validation of 3 Prediction Models for Mortality in Out‐of‐Hospital Cardiac Arrest Survivors: A Retrospective Multicenter Study |
| title_short | External Validation of 3 Prediction Models for Mortality in Out‐of‐Hospital Cardiac Arrest Survivors: A Retrospective Multicenter Study |
| title_sort | external validation of 3 prediction models for mortality in out of hospital cardiac arrest survivors a retrospective multicenter study |
| topic | external validation in‐hospital mortality out‐of‐hospital cardiac arrest predictive models risk stratification |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.125.042033 |
| work_keys_str_mv | AT chunhsianghuang externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT edwardpeichuanhuang externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT chengyifan externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT yichienkuo externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT chientaihuang externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT chingyuchen externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT chihsinchen externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT yijuho externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT chunjulien externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT yunchangchen externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT sihshianghuang externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT tzuhsuehwang externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT wenchuchiang externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT weitienchang externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT chienhuahuang externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy AT chihweisung externalvalidationof3predictionmodelsformortalityinoutofhospitalcardiacarrestsurvivorsaretrospectivemulticenterstudy |