Validation of the NULL‐EASE Score for Predicting Survival in a Multiethnic Asian Cohort of Out‐of‐Hospital Cardiac Arrest
Background NULL‐PLEASE is a simple and accurate clinical scoring system developed in a Western cohort of patients with out‐of‐hospital cardiac arrest (OHCA). The need for blood test results limits its use in early stages of care. We adapted and validated the NULL‐EASE score (without laboratory tests...
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| Format: | Article |
| Language: | English |
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Wiley
2024-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.034133 |
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| author | Shir Lynn Lim Siew Pang Chan Nur Shahidah Kai Lee Woo Sean Shao Wei Lam Benjamin Sieu‐Hon Leong Gregory Y. H. Lip Marcus Eng Hock Ong |
| author_facet | Shir Lynn Lim Siew Pang Chan Nur Shahidah Kai Lee Woo Sean Shao Wei Lam Benjamin Sieu‐Hon Leong Gregory Y. H. Lip Marcus Eng Hock Ong |
| author_sort | Shir Lynn Lim |
| collection | DOAJ |
| description | Background NULL‐PLEASE is a simple and accurate clinical scoring system developed in a Western cohort of patients with out‐of‐hospital cardiac arrest (OHCA). The need for blood test results limits its use in early stages of care. We adapted and validated the NULL‐EASE score (without laboratory tests) in an independent, multiethnic Asian cohort of patients with out‐of‐hospital cardiac arrest. Methods and Results Using the Singapore OHCA registry, we included consecutive adult patients with out‐of‐hospital cardiac arrest who survived to hospital admission between April 2010 to December 2020. In‐hospital mortality was the primary outcome. Logistic regression analyses were performed with STATA MP v18. Of 3274 patients (median age 64, interquartile range 54–75; 67.9% male) included in the study, 2476 (75.6%) had in‐hospital mortality. NULL‐EASE score was significantly lower in survivors compared with nonsurvivors (median [inter quartile range] 3 [1–4] versus 6 [4–7]; P<0.001) and strongly predictive of mortality (area under receiver operating characteristic, 0.81 [95% CI, 0.79–0.83]). Patients with a score of ≥3 had higher odds of mortality (adjusted odds ratio, 8.11 [95% CI, 6.57–10.00]) when compared with those with lower scores, after adjusting for sex, residential arrest, diabetes, respiratory disease, and stroke. A cutoff value of ≥3 predicted mortality with 92.2% sensitivity, 84.1% positive predictive value, 46.1% specificity, and 65.5% negative predictive value. NULL‐EASE score performed better in younger compared with older patients (area under receiver operating characteristic, 0.82 versus 0.77, P=0.008). Conclusions The NULL‐EASE score has good discriminative performance (sensitivity and accuracy) in our multiethnic Asian cohort, but the cutoff of ≥3 falls short of the desired level of specificity for therapeutic decision‐making. |
| format | Article |
| id | doaj-art-e7f03c62babc4d3f908b425682a928a6 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-e7f03c62babc4d3f908b425682a928a62024-11-28T09:27:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-08-01131610.1161/JAHA.123.034133Validation of the NULL‐EASE Score for Predicting Survival in a Multiethnic Asian Cohort of Out‐of‐Hospital Cardiac ArrestShir Lynn Lim0Siew Pang Chan1Nur Shahidah2Kai Lee Woo3Sean Shao Wei Lam4Benjamin Sieu‐Hon Leong5Gregory Y. H. Lip6Marcus Eng Hock Ong7Department of Cardiology National University Heart Centre SingaporeYong Loo Lin School of Medicine National University of Singapore SingaporeDepartment of Emergency Medicine Singapore General Hospital SingaporeDepartment of Cardiology National University Heart Centre SingaporeHealth Services Research Centre Singapore Health Services SingaporeEmergency Department National University Hospital SingaporeLiverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool United KingdomDepartment of Emergency Medicine Singapore General Hospital SingaporeBackground NULL‐PLEASE is a simple and accurate clinical scoring system developed in a Western cohort of patients with out‐of‐hospital cardiac arrest (OHCA). The need for blood test results limits its use in early stages of care. We adapted and validated the NULL‐EASE score (without laboratory tests) in an independent, multiethnic Asian cohort of patients with out‐of‐hospital cardiac arrest. Methods and Results Using the Singapore OHCA registry, we included consecutive adult patients with out‐of‐hospital cardiac arrest who survived to hospital admission between April 2010 to December 2020. In‐hospital mortality was the primary outcome. Logistic regression analyses were performed with STATA MP v18. Of 3274 patients (median age 64, interquartile range 54–75; 67.9% male) included in the study, 2476 (75.6%) had in‐hospital mortality. NULL‐EASE score was significantly lower in survivors compared with nonsurvivors (median [inter quartile range] 3 [1–4] versus 6 [4–7]; P<0.001) and strongly predictive of mortality (area under receiver operating characteristic, 0.81 [95% CI, 0.79–0.83]). Patients with a score of ≥3 had higher odds of mortality (adjusted odds ratio, 8.11 [95% CI, 6.57–10.00]) when compared with those with lower scores, after adjusting for sex, residential arrest, diabetes, respiratory disease, and stroke. A cutoff value of ≥3 predicted mortality with 92.2% sensitivity, 84.1% positive predictive value, 46.1% specificity, and 65.5% negative predictive value. NULL‐EASE score performed better in younger compared with older patients (area under receiver operating characteristic, 0.82 versus 0.77, P=0.008). Conclusions The NULL‐EASE score has good discriminative performance (sensitivity and accuracy) in our multiethnic Asian cohort, but the cutoff of ≥3 falls short of the desired level of specificity for therapeutic decision‐making.https://www.ahajournals.org/doi/10.1161/JAHA.123.034133cardiac arrestprognosisrisk scoressurvival |
| spellingShingle | Shir Lynn Lim Siew Pang Chan Nur Shahidah Kai Lee Woo Sean Shao Wei Lam Benjamin Sieu‐Hon Leong Gregory Y. H. Lip Marcus Eng Hock Ong Validation of the NULL‐EASE Score for Predicting Survival in a Multiethnic Asian Cohort of Out‐of‐Hospital Cardiac Arrest Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac arrest prognosis risk scores survival |
| title | Validation of the NULL‐EASE Score for Predicting Survival in a Multiethnic Asian Cohort of Out‐of‐Hospital Cardiac Arrest |
| title_full | Validation of the NULL‐EASE Score for Predicting Survival in a Multiethnic Asian Cohort of Out‐of‐Hospital Cardiac Arrest |
| title_fullStr | Validation of the NULL‐EASE Score for Predicting Survival in a Multiethnic Asian Cohort of Out‐of‐Hospital Cardiac Arrest |
| title_full_unstemmed | Validation of the NULL‐EASE Score for Predicting Survival in a Multiethnic Asian Cohort of Out‐of‐Hospital Cardiac Arrest |
| title_short | Validation of the NULL‐EASE Score for Predicting Survival in a Multiethnic Asian Cohort of Out‐of‐Hospital Cardiac Arrest |
| title_sort | validation of the null ease score for predicting survival in a multiethnic asian cohort of out of hospital cardiac arrest |
| topic | cardiac arrest prognosis risk scores survival |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.034133 |
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