PROHLÍŽENÍ ABSTRAKTA

CLINICAL AND LABORATORY PREDICTORS OF INFECTIOUS COMPLICATIONS IN PATIENTS AFTER OUT-OF-HOSPITAL CARDIAC ARREST
Tématický okruh: Akutní stavy v kardiologii, Akutní koronární syndromy
Typ: Ústní sdělení - lékařské , Číslo v programu: 209
Přihlášeno do: Soutěž mladých kardiologů

Kroupa J.1, Knot J.1, Ulman J.1, Bednář F.1, Dohnalová A.2, Moťovská Z.1

1 Kardiologická klinika, Fakultní nemocnice Královské Vinohrady, Praha, 2 Fyziologický ústav, 1. lékařská fakulta, Univerzita Karlova, Praha


Aim: The study aimed to identify clinical and laboratory predictors related to infectious complications (IC) in patients after OHCA.
Methods: Patients, aged >18, who suffered an OHCA between 9/2013–11/2015, admitted to coronary care unit, surviving >24 hours, were studied. Comparison of patients with and without IC was performed.
Results: Study group consisted of 42 patients (mean age 63.4 years, 88.1% men). Targeted temperature management (TTM) was used in 76.2% of all cases, 90.5% of patients were mechanically ventilated. Seventy-three percent of patients were discharged with CPC scale 1-2. In-hospital mortality was 11.9%.
Forty percent of patients had IC; lower respiratory tract infections were most common (in 87.5% of cases). IC were more common in patients receiving TTM (50% vs. 10%; p=0.032).
Antibiotic therapy was used in 85.7% of all patients. Mean time to therapy initiation was 9.6 (SD 7.1) hours after admission. Mean time of treatment duration was 9.0 (SD 6.2) days. Fifty-three percent of patients receiving early ATB treatment didn’t have IC. Initial antibiotic therapy was changed more often in patients with IC (75% vs. 38.9%; p=0.045).
Values of C-reactive protein (CRP), procalcitonin (PCT), troponin, creatinine and count of white blood cells (WBC) were higher in patients with IC during first 72 hours. This was significant at the time of 24 hours after admission for PCT (p=0.019) and at the time of 24 and 48 hours for CRP (p=0.007 resp. p=0.012), WBC (p=0.008 resp. p=0.028) and troponin (p=0.036 resp. p=0.043).
Conclusion: Early initiated antibiotic treatment is overused in patients after OHCA. Its early initiation is associated with the necessity of antibiotic change in the majority of patients with IC. Assessment of clinical and laboratory parameters in the first days after OHCA increases the likelihood of appropriate ATB therapy.