External Validation of a Post-Cardiac Arrest Risk Score (SLANT) for In-Hospital Mortality in Patients Receiving Targeted Temperature Management.

Background

Despite improvements in cardiopulmonary resuscitation and post-cardiac arrest care, in-hospital mortality among survivors of out-of-hospital cardiac arrest (OHCA) remains high, particularly in Asia. The SLANT score was developed to predict outcomes in patients with comatose OHCA receiving targeted temperature management (TTM), but its performance outside the original derivation cohort remains uncertain. We aimed to externally validate the SLANT score for predicting in-hospital mortality in an East Asian population.

Method

We conducted a multicentre retrospective cohort study across three tertiary hospitals in Taiwan between 2016 and 2023. Adult patients with OHCA who achieved sustained return of spontaneous circulation, remained comatose, and received TTM were included. The SLANT score-comprising initial non-shockable rhythm, post-TTM leukocyte abnormality, total adrenaline dose ≥5 mg, absence of bystander cardiopulmonary resuscitation, and resuscitation duration ≥20 minutes-was calculated using original definitions. The outcome was in-hospital mortality. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was evaluated with calibration plots.

Results

Among 451 eligible patients, 300 (66.5%) died during hospitalisation. The SLANT score demonstrated good discrimination for in-hospital mortality (AUC 0.746; 95% confidence interval 0.696-0.796), with acceptable calibration, particularly in moderate- to high-risk ranges. A score threshold ≥14 provided the optimal balance between sensitivity (65.7%) and specificity (78.2%), with a positive predictive value of 85.7%.

Conclusions

In this East Asian cohort, the SLANT score showed reasonable discrimination and calibration for predicting in-hospital mortality. These findings support its potential role in post-cardiac arrest risk stratification, while underscoring the need for contextual clinical judgment.