Abstract
ObjectiveTo examine the epidemiology and outcomes of in-hospital cardiopulmonary resuscitation (CPR) among patients with cirrhosis.MethodsWe used the Texas Inpatient Public Use Data File to identify hospitalizations aged ≥ 18 years with and without cirrhosis during 2009–2014 and those in each group who have undergone in-hospital CPR. Short-term survival (defined as absence of hospital mortality or discharge to hospice) following in-hospital CPR was examined. Multivariate logistic regression modeling was used to assess the prognostic impact of cirrhosis following in-hospital CPR and predictors of short-term survival among cirrhosis hospitalizations.ResultsIn-hospital CPR was reported in 2,511 and 51,969 hospitalizations with and without cirrhosis, respectively. The rate of in-hospital CPR (per 1,000 hospitalizations) was 7.6 and 4.0 among hospitalizations with and without cirrhosis, respectively. The corresponding rate of in-hospital CPR among decedents was 10.7% and 13.4%, respectively. Short-term survival following in-hospital CPR among hospitalizations with and without cirrhosis was 14.9% and 27.3%, respectively, and remained unchanged over time on adjusted analyses among the former (p = 0.1753), while increasing among the latter (p = 0.0404). Cirrhosis was associated with lower odds of short-term survival following in-hospital CPR (adjusted odds ratio [aOR] 0.55 [95% CI: 0.49–0.62]). Lack of health insurance (vs. Medicare) (aOR] 0.47 [95% CI: 0.34–0.67]) and sepsis ([aOR] 0.67 [95% CI: 0.53–85]) were associated with lower odds of short-term survival following in-hospital CPR among cirrhosis hospitalizations.ConclusionsThe rate of in-hospital CPR was nearly 2-fold higher among hospitalizations with cirrhosis than among those without it, though it was used more selectively among the former. Short-term survival following in-hospital CPR remained markedly lower among cirrhosis hospitalizations, while progressively improving among those without cirrhosis. Strategies to increase access to health insurance and improve early identification and control of infection should be explored in future preventive and interventional efforts.
Highlights
Cirrhosis is increasingly prevalent in the United States (US) [1] and affected patients commonly experience decompensation events, with estimated 500,000 annual hospitalizations [2]
Data are scarce on the contemporary epidemiology and outcomes of in-hospital cardiopulmonary resuscitation (CPR) among patients with cirrhosis, with reported studies focusing on select older age groups [6], describing outcomes of care provided several decades ago [6, 12], published in a preliminary form [7], or based on small, single-center cohorts [8, 13]
It is unclear whether the aforementioned gains in short-term outcomes among hospitalized cirrhotic patients extend to those undergoing in-hospital CPR
Summary
Cirrhosis is increasingly prevalent in the United States (US) [1] and affected patients commonly experience decompensation events, with estimated 500,000 annual hospitalizations [2]. Data are scarce on the contemporary epidemiology and outcomes of in-hospital CPR among patients with cirrhosis, with reported studies focusing on select older age groups [6], describing outcomes of care provided several decades ago [6, 12], published in a preliminary form [7], or based on small, single-center cohorts [8, 13]. It is unclear whether the aforementioned gains in short-term outcomes among hospitalized cirrhotic patients extend to those undergoing in-hospital CPR. We asked: 1) how often is in-hospital CPR conducted among hospitalized patients with cirrhosis? 2) what are the characteristics of patients with cirrhosis who undergo in-hospital CPR? and 3) what are the short-term outcomes following inhospital CPR among patients with cirrhosis and what factors are associated with these outcomes?
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