Gonuguntla Karthik, Patil Shivaraj, Cowden Richard Gregory, Kumar Manish, Rojulpote Chaitanya, Bhattaru Abhijit, Tiu John Glenn, Robinson Peter
Department of Internal Medicine and Cardiology, Calhoun Cardiology Center University of Connecticut, Farmington, CT, USA.
Department of Psychology, University of the Free State, Bloemfontein, 9301, South Africa.
Ir J Med Sci. 2020 Nov;189(4):1275-1281. doi: 10.1007/s11845-020-02246-y. Epub 2020 May 9.
A left ventricular assist device (LVAD) is used to support patients with end-stage heart failure.
To examine the role of comorbidities and complications in predicting in-hospital mortality since the introduction of continuous flow (CF)-LVAD.
The Nationwide Inpatient Sample was queried from 2010 to 2014 using International Classification of Disease-9 code for LVAD among patients 18 years or older. The sample consisted of 2,359 patients (mean age = 55 ± 13.7 years, 76.8% men, 59.3% Caucasian).
Comparative analysis revealed mortality did not differ from 2010 to 2014 (p = 0.653). Increases in comorbidities of atrial fibrillation, acute kidney injury, mechanical ventilation, body mass index ≥ 25, cerebrovascular disease, and mild liver disease were evidenced over the 5-year period (p values ≤ 0.049). Multivariate analysis showed that significant predictors of mortality were comorbid hemodialysis (AOR = 7.62, 95% CI [4.78, 12.27]), cerebrovascular disease (AOR = 5.38, 95% CI [3.49, 8.26]), mechanical ventilation (AOR = 3.83, 95% CI [2.84, 5.18]), mild liver disease (AOR = 1.96, 95% CI [1.38, 2.76]), and acute kidney injury (AOR = 1.62, 95% CI [1.16, 2.28]). Predictive complications included disseminated intravascular coagulation (AOR = 6.41, 95% CI [2.79, 6.84]), sepsis (AOR = 4.37, 95% CI [2.79, 6.84]), septic shock (AOR = 3.9, 95% CI [2.11, 7.59]), and gastrointestinal bleed (AOR = 1.81, 95% CI [1.11, 2.93]).
CF-LVADs have not reduced mortality, possibly due to utilization in patients with comorbid conditions. Future trials are necessary for improved patient selection and reduced post-procedural complications.
左心室辅助装置（LVAD）用于支持终末期心力衰竭患者。
探讨自连续血流（CF）-LVAD应用以来，合并症和并发症在预测住院死亡率中的作用。
使用国际疾病分类第9版代码，查询2010年至2014年18岁及以上患者中LVAD的全国住院患者样本。样本包括2359例患者（平均年龄=55±13.7岁，76.8%为男性，59.3%为白种人）。
比较分析显示，2010年至2014年死亡率无差异（p=0.653）。5年期间，房颤、急性肾损伤、机械通气、体重指数≥25、脑血管疾病和轻度肝病的合并症有所增加（p值≤0.049）。多变量分析显示，死亡率的显著预测因素包括合并血液透析（比值比[AOR]=7.62，95%置信区间[CI][4.78,12.27]）、脑血管疾病（AOR=5.38，95%CI[3.49,8.26]）、机械通气（AOR=3.83，95%CI[2.84,5.18]）、轻度肝病（AOR=1.96，95%CI[1.38,2.76]）和急性肾损伤（AOR=1.62，95%CI[1.16,2.28]）。预测并发症包括弥散性血管内凝血（AOR=6.41，95%CI[2.79,6.84]）、脓毒症（AOR=4.37，95%CI[2.79,6.84]）、感染性休克（AOR=3.9，95%CI[2.11,7.59]）和胃肠道出血（AOR=1.81，95%CI[1.11,2.93]）。
CF-LVAD并未降低死亡率，可能是由于在合并症患者中使用。未来有必要进行试验以改善患者选择并减少术后并发症。
