University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States; Harvard T H Chan School of Public Health, Boston, MA, United States.
Baystate Medical Center, Springfield, MA, United States.
Resuscitation. 2019 Dec;145:21-25. doi: 10.1016/j.resuscitation.2019.09.030. Epub 2019 Oct 10.
Association between survival rate and Elixhauser Comorbidity Index (ECI) among individuals suffering an out-of-hospital cardiac arrest (OHCA) in the United States (US).
We utilized the US National Emergency Department Sample (NEDS) dataset to retrospectively identify individuals experiencing OHCA between January 1, 2006 to December 31, 2015; using the International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9-CM) and Tenth Revision-Clinical Modification (ICD-10-CM) codes. Logistic regression analysis with twenty-nine ECIs as predictor variables were performed to compute for odds ratio (OR), after controlling for age and gender. Linear regression analysis performed to assess survival trend after clustering based on ECI. We also assessed the association of ECI with survival rate after stratifying patients based on cardiac rhythm (shockable versus non-shockable).
We identified 1,282,520 (16.4%, survived-to-discharge) weighted observations presenting primarily after OHCA in the US during the study period. Annual percentage change (APC) in survival rate among OHCA patients with no ECI and those with >3 ECI was -1.53% (95% CI: -1.98% to -1.09%, P < 0.001) and 1.2% (95% CI: 0.69%-1.7%, P = 0.001), respectively. Adjusted OR for ECI was 1.31 (95% CI: 1.3-1.31, P < 0.001). Percentage change in the survival rate among shockable and non-shockable rhythm was 5.6% (95% CI: -3.9% to 15.13%, P = 0.127) and 1.04% (95% CI: 0.01%-2.07%, P = 0.05), respectively, with a unit increase in ECI.
In the US, OHCA patients with higher ECI have greater survival-to-discharge rate, demonstrating "comorbidity paradox".
研究在美国，生存率与 Elixhauser 合并症指数（ECI）之间的关系，以评估患有院外心脏骤停（OHCA）的个体的预后。
我们利用美国国家急诊部样本（NEDS）数据集，回顾性地确定了 2006 年 1 月 1 日至 2015 年 12 月 31 日期间经历 OHCA 的个体；使用国际疾病分类，第九修订临床修正版（ICD-9-CM）和第十修订临床修正版（ICD-10-CM）代码。使用逻辑回归分析，以 29 个 ECI 作为预测变量，计算比值比（OR），同时控制年龄和性别。基于 ECI 进行聚类后，进行线性回归分析以评估生存率趋势。我们还根据心脏节律（可电击与不可电击）对患者进行分层，评估 ECI 与生存率之间的关系。
我们确定了在研究期间，美国 1282520 例（16.4%，出院时存活）加权观察结果，主要是在 OHCA 后出现的。无 ECI 和 ECI>3 的 OHCA 患者的生存率年变化百分比分别为-1.53%（95%置信区间：-1.98%至-1.09%，P<0.001）和 1.2%（95%置信区间：0.69%至 1.7%，P=0.001）。ECI 的调整后 OR 为 1.31（95%置信区间：1.3-1.31，P<0.001）。可电击与不可电击节律的生存率变化百分比分别为 5.6%（95%置信区间：-3.9%至 15.13%，P=0.127）和 1.04%（95%置信区间：0.01%至 2.07%，P=0.05），ECI 增加一个单位。
在美国，ECI 较高的 OHCA 患者出院时的生存率更高，这表明存在“合并症悖论”。
