Hydrocortisone administration was associated with improved survival in Japanese patients with cardiac arrest

Takahiro Niimura,Ayako Ohshima,Toru Imai,Yoshito Zamami,Yutaka Kondo,Keijo Fukushima,Toshiaki Takahashi ,Yuki Izawa‐Ishizawa ,Toshihiro Koyama,Keisaku Harada,Yuya Horinouchi,Kenshi Takechi,Masashi Miyake,Koichiro Tsuchiya,Yasumasa Ikeda,Mitsunobu R Kano,Tadashi Koga,Shiro Hinotsu,Masaki Imanishi,Hiromichi Fujino,Keisuke Ishizawa

doi:10.1038/s41598-017-17686-3

Abstract

There are few reports on hydrocortisone administration after cardiac arrest, and those that have been published included few subjects. This study aimed to evaluate the effect of hydrocortisone administration on the outcomes of patients who experienced cardiac arrest. We investigated the survival discharge rates and the length of hospital stay from cardiac arrest to discharge, stratified by use of hydrocortisone, using a Japanese health-insurance claims dataset that covers approximately 2% of the Japanese population. The study included the data of 2233 subjects who experienced either in-hospital or out-of-hospital cardiac arrest between January 2005 and May 2014. These patients were divided into two groups, based on the administration of hydrocortisone. We adjusted the baseline characteristics, medical treatment, and drug administration data of the two groups using propensity scores obtained via the inverse probability of treatment weighted method. The hydrocortisone group had a significantly higher survival discharge rate (13/61 [21.1%] vs. 240/2172 [11.0%], adjusted odds ratio: 4.2, 95% CI: 1.60–10.98, p = 0.004). In addition, the administration of hydrocortisone was independent predictor of survival to discharge (hazard ratio: 4.6, p < 0.001). The results demonstrate a correlation between hydrocortisone administration and the high rates of survival to discharge.

Highlights

There are few reports on hydrocortisone administration after cardiac arrest, and those that have been published included few subjects
There is a high frequency of post-resuscitation syndrome in patients who achieve return of spontaneous circulation (ROSC), and the proportion of patients able to return to normal life is extremely low[6]
In the present study, we investigated the rate of survival to discharge among patients who experienced cardiac arrest and received hydrocortisone by analyzing health-insurance claims data owned by the Japan Medical Data Center (JMDC)

Summary

Introduction

There are few reports on hydrocortisone administration after cardiac arrest, and those that have been published included few subjects. The study included the data of 2233 subjects who experienced either in-hospital or out-of-hospital cardiac arrest between January 2005 and May 2014 These patients were divided into two groups, based on the administration of hydrocortisone. The prognosis after cardiac arrest has improved, the rate of surviving to hospital discharge remains < 30%4,5. Several studies have reported that administration of glucocorticoids during and after resuscitation results in improved prognosis for cardiac arrest patients. Tsai et al reported that using glucocorticoids during resuscitation improves the survival discharge rate, using data from the Taiwan National Health Insurance Research Database (NHIRD)[9]

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