KORHN risk score for early neuroprognostication in cardiac arrest patients

Background: Early prediction of poor neurologic outcomes in patients who have recovered spontaneous circulation from out-of-hospital cardiac arrest (OHCA) is the important process that can help family relatives choose a course of treatment. This study aimed to create a scoring tool that could predict an early poor prognosis of comatose survivors from OHCA upon admission and to compare the prognostic value with existing models (MIRACLE, TTM, CAHP, C-GRApH, and OHCA scores). Methods: : Using a cohort from the Korean Hypothermia Network (KORHN) registry in Korea, numerous variables including basic demographics, resuscitation, and post-resuscitation were extracted from 1,371 out of 10,258 OHCA patients. Variables for prognostication were analyzed, and the KORHN risk score was developed from the adjustment of scores through cubic spline plots. The performance of the score was compared with five staple risk scores. Results: : Eight variables for predicting a poor neurologic outcome were identified: low flow time, heart rate/diastolic arterial pressure, noncardiac cause, unreactive pupil reflex, nonshockable rhythm, GCS motor, epinephrine use, and age (adjusted odds ratios 4.287, 3.523, 3.438, 3.393, 3.087, 2.614, 2.526, and 2.419, respectively). The KORHN score showed higher area under the curve values (0.925 and 0.914) than previous risk scores with whole variables (0.827–0.902) and the leading five variables (0.85–0.903). Conclusions: : The KORHN score is a simple tool for the neuroprognostication of OHCA patients during admission. This study confirmed that the KORHN score is a good alternative to the existing scoring models in predicting poor neurological outcomes from OHCA patients. Trial registration: KORHN-PRO, NCT02827422. Registered 11 September 2016 – Retrospectively registered.