This retrospective Singapore cohort classified 1,514 adults resuscitated after presumed cardiac out-of-hospital arrest using 14 laboratory variables within six hours of ROSC. Three phenotypes emerged: multi-organ dysfunction, homeostatic, and immune-dysregulated. Compared with multi-organ dysfunction, adjusted odds of poor neurological recovery at discharge were lower for homeostatic (0.50, 95% CI 0.30–0.78) and immune-dysregulated phenotypes (0.46, 0.26–0.78). Adjusted 30-day mortality hazard ratios were 0.71 (95% CI 0.61–0.83) and 0.78 (0.64–0.94), respectively; lower mortality hazards also persisted at three years.
Early laboratory phenotypes were associated with neurological and mortality outcomes after resuscitated cardiac arrest. These exploratory associations warrant external validation before any phenotype-guided clinical application.
Study limitation: Retrospective associations adjusted only for age, sex and initial rhythm remain vulnerable to residual confounding; validation was internal.
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