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Validation of the NULL‐EASE Score for Predicting Survival in a Multiethnic Asian Cohort of Out‐of‐Hospital Cardiac Arrest

Authors: Shir Lynn Lim; Siew Pang Chan; Nur Shahidah; Kai Lee Woo; Sean Shao Wei Lam; Benjamin Sieu‐Hon Leong; Gregory Y. H. Lip; +11 Authors

Validation of the NULL‐EASE Score for Predicting Survival in a Multiethnic Asian Cohort of Out‐of‐Hospital Cardiac Arrest

Abstract

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.

Keywords

Out-of-Hospital Cardiac Arrest/mortality, Male, Singapore/epidemiology, cardiac arrest, survival, Risk Assessment, Asian People, Risk Factors, Predictive Value of Tests, Diseases of the circulatory (Cardiovascular) system, Humans, Hospital Mortality, Registries, Risk Assessment/methods, risk scores, Original Research, Aged, Survival Rate/trends, Singapore, Reproducibility of Results, Middle Aged, Prognosis, Survival Rate, RC666-701, Female, prognosis, Out-of-Hospital Cardiac Arrest

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
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