{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:44:33Z","timestamp":1789562673959,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T00:00:00Z","timestamp":1674172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Cardiac arrest (CA) can activate blood coagulation. This study aimed to explore the potential prognostic value of prothrombin time\u2013international normalized ratio (INR) in post-CA patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The clinical data of eligible subjects diagnosed with CA was extracted from the MIMIC-IV database as the training cohort. Restricted cubic spline (RCS), Kaplan\u2013Meier (K-M) survival curve, and Cox regression analyses were conducted to elucidate the association between the INR and all-cause mortality of post-CA patients. Subgroup analysis, propensity score matching (PSM), and inverse probability of treatment (IPTW) were also conducted to improve stability and reliability. Data of the validation cohort were collected from the eICU database, and logistic-regression analyses were performed to verify the findings of the training cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1,324 subjects were included in the training cohort. A linear correlation existed between INR and the risk of all-cause death of post-CA patients, as shown in RCS analysis, with a hazard ratio (HR) &amp;gt;1 when INR exceeded 1.2. K-M survival curve preliminarily indicated that subjects with INR \u2265 1.2 presented lower survival rate and shorter survival time, and the high level of INR was independently associated with 30-day, 90-day, 1-year, and in-hospital mortalities, with multivariate-adjusted HR of 1.44 (1.20, 1.73), 1.46 (1.23, 1.74), 1.44 (1.23, 1.69), and 1.37 (1.14, 1.64), respectively. These findings were consistent and robust across the subgroup analysis, PSM and IPTW analyses, and validation cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We systematically and comprehensively demonstrated that elevated INR was associated with increased short- and long-term all-cause mortality of post-CA patients. Therefore, elevated INR may be a promising biomarker with prognosis significance.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1112623","type":"journal-article","created":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T05:39:53Z","timestamp":1674193193000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Association between prothrombin time-international normalized ratio and prognosis of post-cardiac arrest patients: A retrospective cohort study"],"prefix":"10.3389","volume":"11","author":[{"given":"Yiyang","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaixin","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benhui","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baohua","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofang","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilu","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihuang","family":"Zha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3385","DOI":"10.1161\/01.CIR.0000147236.85306.15","article-title":"Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa)","volume":"110","author":"Jacobs","year":"2004","journal-title":"Circulation."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e153","DOI":"10.1161\/CIR.0000000000001052","article-title":"Heart disease and stroke statistics-2022 update: a report from the american heart association","volume":"145","author":"Tsao","year":"2022","journal-title":"Circulation."},{"key":"B3","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.resuscitation.2020.10.005","article-title":"Cardiac arrest and related mortality in emergency departments in the United States: Analysis of the nationwide emergency department sample","volume":"157","author":"Ravindran","year":"2020","journal-title":"Resuscitation."},{"key":"B4","doi-asserted-by":"publisher","first-page":"885406","DOI":"10.3389\/fcvm.2022.885406","article-title":"Association of histones with coagulofibrinolytic responses and organ dysfunction in adult post-cardiac arrest syndrome","volume":"9","author":"Mizugaki","year":"2022","journal-title":"Front Cardiovasc Med."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.20452\/pamw.16325","article-title":"A nomogram to predict in-hospital mortality in patients with post-cardiac arrest: a retrospective cohort study","author":"Chen","year":"2022","journal-title":"Pol Arch Intern Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2452","DOI":"10.1161\/CIRCULATIONAHA.108.190652","article-title":"Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council","volume":"118","author":"Neumar","year":"2008","journal-title":"Circulation"},{"key":"B7","doi-asserted-by":"publisher","first-page":"S440","DOI":"10.1097\/CCM.0b013e31818a89f4","article-title":"Targeting mitochondria for resuscitation from cardiac arrest","volume":"36","author":"Ayoub","year":"2008","journal-title":"Crit Care Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"156","DOI":"10.3389\/fmed.2017.00156","article-title":"Coagulofibrinolytic changes in patients with post-cardiac arrest syndrome","volume":"4","author":"Wada","year":"2017","journal-title":"Front Med (Lausanne)."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1111\/jth.14480","article-title":"Disseminated intravascular coagulation in cardiac arrest and resuscitation","volume":"17","author":"Gando","year":"2019","journal-title":"J Thromb Haemost."},{"key":"B10","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.resuscitation.2016.11.017","article-title":"Fibrin\/fibrinogen degradation products (FDP) at hospital admission predict neurological outcomes in out-of-hospital cardiac arrest patients","volume":"111","author":"Ono","year":"2017","journal-title":"Resuscitation."},{"key":"B11","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1016\/j.amjcard.2013.03.057","article-title":"Usefulness of the D-dimer concentration as a predictor of mortality in patients with out-of-hospital cardiac arrest","volume":"112","author":"Szymanski","year":"2013","journal-title":"Am J Cardiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1055\/s-0040-1719029","article-title":"Prolonged activated partial thromboplastin time after successful resuscitation from cardiac arrest is associated with unfavorable neurologic outcome","volume":"121","author":"Schriefl","year":"2021","journal-title":"Thromb Haemost."},{"key":"B13","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.archger.2017.10.021","article-title":"Prognostic significance of a prolonged international normalized ratio in elderly patients in an internal medicine ward","volume":"74","author":"Plotnikov","year":"2018","journal-title":"Arch Gerontol Geriatr."},{"key":"B14","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1097\/TA.0000000000000954","article-title":"Elevated admission international normalized ratio strongly predicts mortality in victims of abusive head trauma","volume":"80","author":"Leeper","year":"2016","journal-title":"J Trauma Acute Care Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.surg.2014.03.009","article-title":"Impact of prothrombin time-international normalized ratio on outcome of patients with septic shock receiving polymyxin B cartridge hemoperfusion","volume":"156","author":"Ishizuka","year":"2014","journal-title":"Surgery."},{"key":"B16","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1111\/ene.12352","article-title":"Higher baseline international normalized ratio value correlates with higher mortality in intracerebral hemorrhage during warfarin use","volume":"21","author":"Curtze","year":"2014","journal-title":"Eur J Neurol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1253\/circj.CJ-15-1326","article-title":"Prognostic value of prothrombin time international normalized ratio in acute decompensated heart failure- a combined marker of hepatic insufficiency and hemostatic abnormality","volume":"80","author":"Okada","year":"2016","journal-title":"Circ J."},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.13026\/6mm1-ek67","article-title":"MIMIC-IV (version 20)","author":"Johnson","year":"2022","journal-title":"PhysioNet."},{"key":"B19","doi-asserted-by":"publisher","first-page":"E215","DOI":"10.1161\/01.CIR.101.23.e215","article-title":"PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals","volume":"101","author":"Goldberger","year":"2000","journal-title":"Circulation."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.13026\/C2WM1R","article-title":"eICU Collaborative Research Database (version 2.0)","author":"Pollard","year":"2019","journal-title":"PhysioNet"},{"key":"B21","doi-asserted-by":"publisher","first-page":"180178","DOI":"10.1038\/sdata.2018.178","article-title":"The eICU Collaborative Research Database, a freely available multi-center database for critical care research","volume":"5","author":"Pollard","year":"2018","journal-title":"Sci Data."},{"key":"B22","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.cca.2020.02.007","article-title":"The association of coagulation indicators with in-hospital mortality and 1-year mortality of patients with sepsis at ICU admissions: a retrospective cohort study","volume":"504","author":"Zheng","year":"2020","journal-title":"Clin Chim Acta."},{"key":"B23","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1186\/s12872-022-02619-4","article-title":"The association between prothrombin time-international normalized ratio and long-term mortality in patients with coronary artery disease: a large cohort retrospective study with 44,662 patients","volume":"22","author":"Liu","year":"2022","journal-title":"BMC Cardiovasc Disord."},{"key":"B24","first-page":"66","article-title":"Effect of prothrombin time prolongation on survival outcome in out-of-hospital cardiac arrest: a multicenter observational study","volume":"29","author":"Ki Hong Kim","year":"2018","journal-title":"J Korean Soc Emergency."},{"key":"B25","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1055\/s-0038-1657371","article-title":"Calibration of reference thromboplastins and standardisation of the prothrombin time ratio","volume":"49","author":"Kirkwood","year":"1983","journal-title":"Thromb Haemost."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1001\/jama.2020.0945","article-title":"Confirming point-of-care INR test results","volume":"323","author":"Fantz","year":"2020","journal-title":"JAMA."},{"key":"B27","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/s12959-022-00422-x","article-title":"Early coagulopathy after pediatric out-of-hospital cardiac arrest: secondary analysis of a randomized clinical trial","volume":"20","author":"Zhou","year":"2022","journal-title":"Thromb J."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1617","DOI":"10.1016\/j.ajem.2017.04.077","article-title":"Disseminated intravascular coagulation is associated with the neurologic outcome of cardiac arrest survivors","volume":"35","author":"Lee","year":"2017","journal-title":"Am J Emerg Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"16037","DOI":"10.1038\/nrdp.2016.37","article-title":"Disseminated intravascular coagulation","volume":"2","author":"Gando","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"B30","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.resuscitation.2012.09.003","article-title":"Prognostic implication of initial coagulopathy in out-of-hospital cardiac arrest","volume":"84","author":"Kim","year":"2013","journal-title":"Resuscitation."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1016\/j.ajem.2015.05.008","article-title":"Hypoxic hepatitis in survivors of out-of-hospital cardiac arrest","volume":"33","author":"Oh","year":"2015","journal-title":"Am J Emerg Med."},{"key":"B32","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.resuscitation.2019.02.038","article-title":"Hypoxic liver injury after in- and out-of-hospital cardiac arrest: risk factors and neurological outcome","volume":"137","author":"Roedl","year":"2019","journal-title":"Resuscitation."},{"key":"B33","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.jjcc.2020.03.007","article-title":"The Sequential Organ Failure Assessment (SOFA) score predicts mortality and neurological outcome in patients with post-cardiac arrest syndrome","volume":"76","author":"Matsuda","year":"2020","journal-title":"J Cardiol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction\/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine","volume":"22","author":"Vincent","year":"1996","journal-title":"Intensive Care Med"},{"key":"B35","doi-asserted-by":"publisher","first-page":"2957","DOI":"10.1001\/jama.270.24.2957","article-title":"A new Simplified Acute Physiology Score (SAPS II) based on a European\/North American multicenter study","volume":"270","author":"Le Gall","year":"1993","journal-title":"JAMA"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e0196197","DOI":"10.1371\/journal.pone.0196197","article-title":"Performance on the APACHE II, SAPS II, SOFA and the OHCA score of post-cardiac arrest patients treated with therapeutic hypothermia","volume":"13","author":"Choi","year":"2018","journal-title":"PLoS ONE."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1112623\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T05:39:58Z","timestamp":1674193198000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1112623\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,20]]},"references-count":36,"alternative-id":["10.3389\/fpubh.2023.1112623"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1112623","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,20]]},"article-number":"1112623"}}