Function of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
Function of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden; Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Resuscitation. 2018 Mar;124:29-34. doi: 10.1016/j.resuscitation.2017.12.025. Epub 2017 Dec 26.
Co-morbidities affect survival after in-hospital cardiac arrests (IHCA). The risk population for IHCA, i.e. the hospitalised patients, have a doubled increase in co-morbidities over time. A similar increase in co-morbidities among IHCAs might explain the relatively poor survival ratios despite improved care.
To assess changes in the burden of baseline age-adjusted Charlson co-morbidity index (ACCI) scores among IHCAs as well as to assess its impact on survival in three time periods.
All patients ≥18 years suffering an IHCA at Karolinska University Hospital between 1st January 2007 and 31st December 2015 were included. Data regarding the IHCA, patient characteristics, ACCI and 30 day survival were obtained from electronic patient records. Parameters included in ACCI were assessed as ICD-10 codes in the medical file at admission to hospital. The median ACCI with interquartile range (IQR) was presented per year. ACCI was categorised into low 0-2points, moderate 3-5points, high 6-8 points and very high ≥9 points. Differences in survival between 2007 and 2009 and 2010-2012 as well as 2013-2015 were stratified per ACCI category and assessed with adjusted logistic regression models and presented as Odds Ratios with 95% Confidence Intervals (OR, 95% CI). Adjustments included hospital site, sex, first rhythm, ECG-surveillance, witnessed or not, and location of the IHCA.
In all, 1373 patients suffered an IHCA, of whom 376 (27%) survived at least 30 days. The ACCI remained almost constant over time at median 4, IQR 3-6. Patients with low or moderate ACCI more than doubled their survival in 2013-2015 compared to 2007-2009 (adjusted OR 2.61 95% CI1.38-4.94 and OR 1.87 95% CI 1.14-3.09 respectively).
This cohort study illuminates an almost constant burden of co-morbidities over time among patients suffering an IHCA. Further, the study highlights that 30-day survival has almost doubled from 2007 to 2009 to 2013-2015 among those with low to moderate AccI.
合并症会影响院内心搏骤停（IHCA）后的生存。IHCA 的风险人群，即住院患者，其合并症的风险增加了一倍。IHCA 中合并症的类似增加可能解释了尽管护理有所改善，但相对较差的生存率。
评估 2007 年 1 月 1 日至 2015 年 12 月 31 日期间，在卡罗林斯卡大学医院发生的 IHCA 患者中基线年龄调整 Charlson 合并症指数（ACCI）评分的负担变化，并评估其在三个时间段内对生存的影响。
纳入所有年龄≥18 岁，在卡罗林斯卡大学医院发生 IHCA 的患者。从电子病历中获得有关 IHCA、患者特征、ACCI 和 30 天生存的数据。ACCI 中包含的参数在入院时通过医疗档案中的 ICD-10 代码进行评估。每年呈现中位数（四分位距 IQR）的 ACCI。ACCI 分为低 0-2 分、中 3-5 分、高 6-8 分和非常高≥9 分。根据 ACCI 类别对 2007 年至 2009 年和 2010 年至 2012 年以及 2013 年至 2015 年的生存差异进行分层，并使用调整后的逻辑回归模型进行评估，并以 95%置信区间（OR，95%CI）呈现优势比。调整包括医院地点、性别、首次节律、心电图监测、是否目击以及 IHCA 的位置。
共有 1373 名患者发生 IHCA，其中 376 名（27%）至少存活 30 天。ACCI 随时间推移几乎保持不变，中位数为 4，IQR 为 3-6。2013-2015 年，低或中 ACCI 患者的生存率比 2007-2009 年增加了一倍以上（调整后的 OR 2.61，95%CI1.38-4.94 和 OR 1.87，95%CI 1.14-3.09）。
本队列研究阐明了 IHCA 患者中合并症负担随时间的变化几乎保持不变。此外，研究表明，2007 年至 2009 年至 2013 年至 2015 年期间，低至中度 AccI 的患者 30 天生存率几乎翻了一番。
