Predictive value of bedside ultrasound-assessed left ventricular ejection fraction for neurological prognosis in patients after return of spontaneous circulation following in-hospital cardiac arrest: a retrospective cohort study

Abstract

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.

Keywords

In-hospital cardiac arrest / Left ventricular ejection fraction / Neurological prognosis / Point of care ultrasound / Predictive value

Conflict of interest statement

The authors declare no conflict of interest.

Author contributions

Zhong Z, Luo C, and Xu P contributed to study design; Gao X, Huang X, Ren Y, and Chen Y contributed to data acquisition; Zhong Z, Gao X, and Xu P contributed to statistical analysis; Zhong Z and Luo C contributed to data interpretation; Zhong Z and Xu P contributed to manuscript drafting; Luo C and Xu P contributed to manuscript revision. All authors made substantial intellectual contributions to the conceptualization and design of the study, data acquisition and analysis, and the drafting and critical revision of the manuscript. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of this work.

Funding

This work was supported by the Sichuan Science and Technology Program (2024JDKP0021), the Open Foundation of Artificial Intelligence Key Laboratory of Sichuan Province (2020RYY03), the Health Commission of Zigong High-Level Talent Development Project (WJW-GCCRC024), the Sichuan Medical Association Scientific Research Project (S22083), and the Research Project of Zigong City Science and Technology and Intellectual Property Right Bureau (2023-YGY-3-04).

Ethical approval of studies and informed consent

The study followed the principles of the Declaration of Helsinki as revised in 2013. This study was approved, and written informed consent was waived by the Biomedical Ethics Committee of Zigong Fourth People’s Hospital (Approval No. 2020-009, July 20, 2020) owing to the anonymized retrospective nature of the analysis.

Acknowledgements

The authors thank all participants who made this study possible.

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