Saeed Fahad, Adil Malik M, Malik Ahmed A, Schold Jesse D, Holley Jean L
Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio;
Department of Neurology, Ochsner Clinic Foundation and Ochsner Neuroscience Institute, New Orleans, Louisiana;
J Am Soc Nephrol. 2015 Dec;26(12):3093-101. doi: 10.1681/ASN.2014080766. Epub 2015 Apr 23.
Outcomes of cardiopulmonary resuscitation (CPR) in hospitalized patients with ESRD requiring maintenance dialysis are unknown. Outcomes of in-hospital CPR in these patients were compared with outcomes in the general population using data from the Nationwide Inpatient Sample (NIS; 2005-2011). The study population included all adults (≥ 18 years old) from the general population and those with a history of ESRD. Baseline characteristics, in-hospital complications, and discharge outcomes were compared between the two groups. The effects of in-hospital CPR on mortality, length of stay, hospitalization charges, and discharge destination were analyzed. Yearly national trends in survival, discharge to home, and length of stay were also examined using the Cochran-Armitage trend test. During the study period, 56,069 patients with ESRD underwent in-hospital CPR compared with 323,620 patients from the general population. Unadjusted in-hospital mortality rates were higher in patients with ESRD (73.9% versus 71.8%, P<0.001) on univariate analysis. After adjusting for age, gender, and potential confounders, patients with ESRD had higher odds of mortality (odds ratio, 1.24; 95% confidence interval, 1.11 to 1.3; P<0.001). Survival after CPR improved in the year 2011 compared with 2005 (31% versus 21%, P<0.001). Multivariate analysis also revealed that a greater proportion of patients with ESRD who survived were discharged to skilled nursing facilities. In conclusion, outcomes after in-hospital CPR are improving in patients with ESRD but remain worse than outcomes in the general population. Patients with ESRD who survive are more likely to be discharged to nursing homes.
需要维持透析的终末期肾病（ESRD）住院患者心肺复苏（CPR）的结果尚不清楚。利用全国住院患者样本（NIS；2005 - 2011年）的数据，将这些患者的院内心肺复苏结果与普通人群的结果进行了比较。研究人群包括普通人群中的所有成年人（≥18岁）以及有ESRD病史的成年人。比较了两组的基线特征、院内并发症和出院结局。分析了院内心肺复苏对死亡率、住院时间、住院费用和出院目的地的影响。还使用 Cochr an - Armitage趋势检验研究了生存、出院回家和住院时间的年度全国趋势。在研究期间，56,069例ESRD患者接受了院内心肺复苏，而普通人群中有323,620例患者接受了院内心肺复苏。单因素分析显示，ESRD患者的未调整院内死亡率较高（73.9%对71.8%，P<0.001）。在调整年龄、性别和潜在混杂因素后，ESRD患者的死亡几率更高（优势比，1.24；95%置信区间，1.11至1.3；P<0.001）。与2005年相比，2011年心肺复苏后的生存率有所提高（31%对21%，P<0.001）。多因素分析还显示，存活的ESRD患者中更大比例被出院到专业护理机构。总之，ESRD患者院内心肺复苏后的结局正在改善，但仍比普通人群的结局差。存活的ESRD患者更有可能出院到疗养院。
