Outcome of in- and out-of-hospital cardiac arrest survivors with liver cirrhosis

Roedl, Kevin; Wallmüller, Christian; Drolz, Andreas; Horvatits, Thomas; Rutter, Karoline; Spiel, Alexander; Ortbauer, Julia; Stratil, Peter; Hubner, Pia; Weiser, Christoph; Motaabbed, Jasmin Katrin; Jarczak, Dominik; Herkner, Harald; Sterz, Fritz; Fuhrmann, Valentin

doi:10.1186/s13613-017-0322-1

Cited by 24 publications

(40 citation statements)

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“…Mortality in our critically ill patients with cirrhosis was high (>50% died within 1 year following ICU admission), which is comparable to earlier studies in this field . In keeping with the literature, lactate levels were associated with poor outcome in our patients with cirrhosis (Fig.…”

Section: Discussionsupporting

confidence: 91%

“…SOFA, median (IQR) 11 (7)(8)(9)(10)(11)(12)(13)(14) CLIF-SOFA, median (IQR) 12 (8)(9)(10)(11)(12)(13)(14)(15) CLIF-C ACLF score, median (IQR) 53.6 (45.0-61. (P < 0.01 for all).…”

Section: Part 1: Lactate Levels In Critically Ill Patients With Livermentioning

confidence: 99%

“…Mortality rates in patients with cirrhosis treated at the ICU range between 40% and 60% . Different scoring systems have been developed in order to assess prognosis in patients with cirrhosis and ACLF .…”

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confidence: 99%

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Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis: A Multinational Study

et al. 2018

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Section: Discussionsupporting

confidence: 91%

“…SOFA, median (IQR) 11 (7)(8)(9)(10)(11)(12)(13)(14) CLIF-SOFA, median (IQR) 12 (8)(9)(10)(11)(12)(13)(14)(15) CLIF-C ACLF score, median (IQR) 53.6 (45.0-61. (P < 0.01 for all).…”

Section: Part 1: Lactate Levels In Critically Ill Patients With Livermentioning

confidence: 99%

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Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis: A Multinational Study

et al. 2018

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“…Prior studies have demonstrated that patients with shockable rhythms have higher odds of survival after receipt of in‐hospital CPR compared to those with non‐shockable rhythms . Hospitalized patients with cirrhosis are less likely to have a cardiac aetiology of their cardiac arrests and are more likely to have an initial non‐shockable rhythm of pulseless electrical activity or asystole . Unfortunately, we do not have specific data on the aetiology of cardiac arrest in this cohort.…”

Section: Discussionmentioning

confidence: 91%

Outcomes of in‐hospital cardiopulmonary resuscitation for patients with end‐stage liver disease

Ufere

Brahmania

Sey

et al. 2019

Liver International

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Background and Aims:There have been improving survival trends after in-hospital cardiac arrest for the general population, but there is limited information on the outcomes of hospitalized patients with end-stage liver disease (ESLD) who undergo cardiopulmonary resuscitation (CPR). We aimed to examine survival to hospital discharge after receipt of in-hospital CPR in patients with ESLD using a nationally representative sample. Methods:We used the Nationwide Inpatient Sample database from 2006 to 2014 to identify adult patients who underwent in-hospital CPR. Using multivariate modelling, we compared survival to hospital discharge for patients with ESLD to those without ESLD. We also compared outcomes of patients with ESLD to patients with metastatic cancer.Results: A total of 177 533 patients underwent in-hospital CPR, of which 1474 (0.8%) had ESLD. Patients with ESLD had lower rates of survival to hospital discharge compared to patients without ESLD (10.7% vs 28.6%, P < 0.01). In multivariate modelling, ESLD was significantly associated with lower odds of survival to hospital discharge after in-hospital CPR (OR 0.35, 95% CI 0.28-0.44, P < 0.01). Among survivors of inhospital CPR, ESLD patients had a significantly lower chance of discharge to home compared to patients without ESLD (3.2% vs 8.0%, P < 0.05). Patients with ESLD also had lower rates of survival to hospital discharge compared to those with metastatic cancer (10.7% vs 15.5%, P < 0.01). Conclusions:Outcomes are poor after in-hospital CPR in patients with ESLD and are worse than for patients with metastatic cancer. The current analysis can be used to inform goals of care discussions for patients with ESLD. K E Y W O R D S cardiac arrest, code status, decompensated cirrhosis, goals of care | 1257 UFERE Et al. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Ufere NN, Brahmania M, Sey M, et al. Outcomes of in-hospital cardiopulmonary resuscitation for patients with end-stage liver disease. Liver Int.

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“…Of all cardiac arrests in patients with pulmonary hypertension, 50% are due to the progression of the underlying disease, so this complication must be prevented from occurring in the first place due to the very low chance of recovery [ 15 ]. Similarly for patients with cirrhosis, cardiac arrest is a marker of a very poor prognosis; in one study, only 19% of these patients survived and of these patients, most had very poor neurological recovery 1 month after surviving cardiac arrest [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

In-Hospital Outcomes of Patients With Pulmonary Hypertension and Cirrhosis: A 6-Year Population Cohort Study of Over One Million Patients

et al. 2020

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Introduction There is a paucity of data on the influence of sex, race, insurance, pulmonary hypertension-related complications, and cirrhosis-related complications on mortality, hospital length of stay (LOS), and total hospital charges. The aim of this study was to identify risk factors in a national population cohort (in the USA) admitted to hospital between 2012 and 2017. Methods All patients aged > 18 years with pulmonary hypertension and cirrhosis, who had been admitted to hospital between 2012 and 2017, were identified from the US Nationwide Inpatient Sample (NIS), a large publicly available all-payer inpatient care database in the USA. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, average length of hospital stay, and hospital charges, after adjusting for age, gender, race, primary insurance payer status, hospital type and size (number of beds), hospital region, hospital teaching status, and other demographic characteristics. Results Our study identified 1,111,594 patients who had been discharged from hospital from 2012 to 2017. Of these patients, 355,455 were admitted with pulmonary hypertension, with 9.8% having cirrhosis as a complication ( n = 34,986). The analysis revealed that patients with both pulmonary hypertension and cirrhosis compared to patients with only pulmonary hypertension experience increased mortality, hospital LOS, total hospital charges, and pulmonary hypertension-related and cirrhosis-related complications. Independent positive predictors of mortality were Asian/Pacific Islander race and "other" insurance status (worker’s compensation; other US health benefits plans [CHAMPUS/TRICARE, CHAMPVA, Title V]). Independent positive predictors of increased hospital LOS were black race and "other" patients (more than one race/mixed). Independent positive predictors of increased total hospital charges were male gender, Hispanic ethnicity, Asian/Pacific Islander race, and other insurance status. Pulmonary hypertension-related complications (cor pulmonale, pulmonary embolism, hemoptysis, cardiac arrest, atrial fibrillation, ventricular tachycardia) and cirrhosis-related complications (ascites, hepatorenal syndrome, hepatic encephalopathy, variceal bleeding, portal hypertension) were independent positive predictors of mortality, hospital LOS, and total hospital charges. Conclusions Patients with pulmonary hypertension and cirrhosis have increased mortality and hospital utilization compared to patients with only pulmonary hypertension. We identified key drivers for these outcomes. Targeted interventions, such as novel medications, right-to-left shunts, more evaluations for lung transplantation, and reversal of pulmonary vacular remodeling, are needed for the subgroups identified in this study in order to improve outcomes.

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Outcome of in- and out-of-hospital cardiac arrest survivors with liver cirrhosis

Cited by 24 publications

References 44 publications

Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis: A Multinational Study

Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis: A Multinational Study

Outcomes of in‐hospital cardiopulmonary resuscitation for patients with end‐stage liver disease

In-Hospital Outcomes of Patients With Pulmonary Hypertension and Cirrhosis: A 6-Year Population Cohort Study of Over One Million Patients

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