Background: Poor neurological recovery after in-hospital cardiac arrest (IHCA) may be exacerbated by postresuscitation myocardial dysfunction. However, the predictive value of left ventricular ejection fraction (LVEF) for neurological outcomes remains insufficiently explored. Methods: This retrospective study included patients with IHCA who achieved return of spontaneous circulation at the Zigong Fourth People’s Hospital between 2019 and 2024. Neurological function at discharge was evaluated using the cerebral performance category (CPC) score (favorable: CPC ≤ 2; unfavorable: CPC > 2). Multivariable logistic regression, restricted cubic splines, and receiver operating characteristic curves were used to evaluate the predictive performance. The incremental value of LVEF was assessed using net reclassification improvement and integrated discrimination improvement. Decision and calibration curves were used to assess clinical utility. Results: Of the 179 patients, 31 (17.3%) exhibited favorable neurological outcomes. After adjusting for mechanical ventilation and consciousness levels, LVEF remained an independent predictor of favorable recovery (odds ratio: 1.057; 95% confidence interval CI: 1.005–1.112; P = 0.032). Restricted cubic splines analysis demonstrated a linear dose–response relation between LVEF and favorable outcomes ( P for nonlinearity = 0.984). The integrated model incorporating LVEF, cardiac arrest survival postresuscitation in-hospital, and modified early warning score yielded an area under the curve of 0.869 (95% CI: 0.803–0.935). Bootstrap analysis identified an optimal LVEF threshold of 58% (95% CI: 55%–65%). The addition of LVEF to conventional scoring systems improved both the net reclassification improvement and integrated discrimination improvement ( P < 0.05), with the decision curve analysis confirming an enhanced net clinical benefit. Calibration curves showed good agreement between the predicted and observed outcomes. Conclusion: Bedside ultrasonographic assessment of LVEF is an independent linear predictor of neurological recovery in patients with IHCA. Incorporating LVEF into existing clinical frameworks (cardiac arrest survival postresuscitation in-hospital and modified early warning score) enhances the prognostic accuracy and risk stratification, providing objective evidence for early clinical decision-making.
Zhong et al. (Thu,) studied this question.