Abstract
BackgroundWe studied the association between cardiorenal function and survival, neurological outcome and trends in survival after in-hospital cardiac arrest (IHCA). MethodsWe included cases aged ≥ 18 years in the Swedish Cardiopulmonary Resuscitation Registry during 2008 to 2020. The CKD-EPI equation was used to calculate estimated glomerular filtration rate (eGFR). A history of heart failure was defined according to contemporary guideline criteria. Logistic regression was used to study survival. Neurological outcome was assessed using cerebral performance category (CPC). ResultsWe studied 22,819 patients with IHCA. The 30-day survival was 19.3%, 16.6%, 22.5%, 28.8%, 39.3%, 44.8% and 38.4% in cases with eGFR < 15, 15–29, 30–44, 45–59, 60–89, 90–130 and 130–150 ml/min/1.73 m2, respectively. All eGFR levels below and above 90 ml/min/1.73 m2 were associated with increased mortality. Probability of survival at 30 days was 62% lower in cases with eGFR < 15 ml/min/1.73 m2, compared with normal kidney function. At every level of eGFR, presence of heart failure increased mortality markedly; patients without heart failure displayed higher mortality only at eGFR below 30 ml/min/1.73 m2. Among survivors with eGFR < 15 ml/min/1.73 m2, good neurological outcome was noted in 87.2%. Survival increased in most groups over time, but most for those with eGFR < 15 ml/min/1.73 m2, and least for those with normal eGFR. ConclusionsAll eGFR levels below and above normal range are associated with increased mortality and this association is modified by the presence of heart failure. Neurological outcome is good in the majority of cases, across kidney function levels and survival is increasing.
Highlights
Renal dysfunction is a strong predictor of coronary artery disease, acute myocardial infarction, peripheral artery disease, heart failure and death.[1,2] In patients with end-stage renal dysfunction, more than 50% die from cardiovascular events
A total of 22,819 patients with in-hospital cardiac arrest (IHCA) were included; 13,076 (57.3%) patients had an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m2 and met the criteria of CKD
Left ventricular ejection fraction (EF) was higher in the groups with higher eGFR. This applies to all eGFR groups apart from the patients with eGFR < 15 and eGFR 15–29 ml/min/1.73 m2, where mean EF was 41.2% and 39.3%, respectively
Summary
Renal dysfunction is a strong predictor of coronary artery disease, acute myocardial infarction, peripheral artery disease, heart failure and death.[1,2] In patients with end-stage renal dysfunction, more than 50% die from cardiovascular events. We studied the association between cardiorenal function and survival, neurological outcome and trends in survival after in-hospital cardiac arrest (IHCA). The 30-day survival was 19.3%, 16.6%, 22.5%, 28.8%, 39.3%, 44.8% and 38.4% in cases with eGFR < 15, 15–29, 30–44, 45–59, 60–89, 90–130 and 130–150 ml/min/1.73 m2, respectively. All eGFR levels below and above 90 ml/min/1.73 m2 were associated with increased mortality. Probability of survival at 30 days was 62% lower in cases with eGFR < 15 ml/min/1.73 m2, compared with normal kidney function. Conclusions: All eGFR levels below and above normal range are associated with increased mortality and this association is modified by the presence of heart failure. Neurological outcome is good in the majority of cases, across kidney function levels and survival is increasing.
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