Duazo Catherine, Hsiung Jo-Ching, Qian Frank, Sherrod Charles Fox, Ling Dean-An, Wu I-Ju, Hsu Wan-Ting, Liu Ye, Wei Chen, Tehrani Babak, Hsu Tzu-Chun, Lee Chien-Chang
Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States.
Department of Medicine, National Taiwan University, Taipei, Taiwan.
Front Med (Lausanne). 2021 Oct 15;8:731266. doi: 10.3389/fmed.2021.731266. eCollection 2021.
Little is known about the risk of in-hospital cardiac arrest (IHCA) among patients with sepsis. We aimed to characterize the incidence and outcome of IHCA among patients with sepsis in a national database. We then determined the major risk factors associated with IHCA among sepsis patients. We used data from a population-based cohort study based on the National Health Insurance Research Database of Taiwan (NHRID) between 2000 and 2013. We used Martin's implementation that combined the explicit ICD-9 CM codes for sepsis and six major organ dysfunction categories. IHCA among sepsis patients was identified by the presence of cardiopulmonary resuscitation procedures. The survival impact was analyzed with the Cox proportional-hazards model using inverse probability of treatment weighting (IPTW). The risk factors were identified by logistic regression models with 10-fold cross-validation, adjusting for competing risks. We identified a total of 20,022 patients with sepsis, among whom 2,168 developed in-hospital cardiac arrest. Sepsis patients with a higher burden of comorbidities and organ dysfunction were more likely to develop in-hospital cardiac arrest. Acute respiratory failure, hematological dysfunction, renal dysfunction, and hepatic dysfunction were associated with increased risk of IHCA. Regarding the source of infection, patients with respiratory tract infections were at the highest risk, whereas patients with urinary tract infections and primary bacteremia were less likely to develop IHCA. The risk of IHCA correlated well with age and revised cardiac risk index (RCRI). The final competing risk model concluded that acute respiratory failure, male gender, and diabetes are the three strongest predictors for IHCA. The effect of IHCA on survival can last 1 year after hospital discharge, with an IPTW-weighted hazard ratio of 5.19 (95% CI: 5.06, 5.35) compared to patients who did not develop IHCA. IHCA in sepsis patients had a negative effect on both short- and long-term survival. The risk of IHCA among hospitalized sepsis patients was strongly correlated with age and cardiac risk index. The three identified risk factors can help clinicians to identify patients at higher risk for IHCA.
关于脓毒症患者发生院内心脏骤停（IHCA）的风险，目前所知甚少。我们旨在通过一个全国性数据库来描述脓毒症患者中IHCA的发病率和转归情况。然后，我们确定了脓毒症患者中与IHCA相关的主要危险因素。我们使用了基于台湾国民健康保险研究数据库（NHRID）在2000年至2013年期间进行的一项基于人群的队列研究的数据。我们采用了Martin的方法，该方法结合了脓毒症的明确国际疾病分类第九版临床修正版（ICD - 9 CM）编码和六个主要器官功能障碍类别。脓毒症患者中的IHCA通过心肺复苏程序的实施情况来确定。使用逆概率处理加权（IPTW）的Cox比例风险模型分析生存影响。通过具有10倍交叉验证的逻辑回归模型确定危险因素，并对竞争风险进行调整。我们共识别出20,022例脓毒症患者，其中2,168例发生了院内心脏骤停。合并症负担和器官功能障碍较重的脓毒症患者更易发生院内心脏骤停。急性呼吸衰竭、血液学功能障碍、肾功能障碍和肝功能障碍与IHCA风险增加相关。关于感染源，呼吸道感染患者的风险最高，而尿路感染和原发性菌血症患者发生IHCA的可能性较小。IHCA的风险与年龄和修订后的心脏风险指数（RCRI）密切相关。最终的竞争风险模型得出结论，急性呼吸衰竭、男性性别和糖尿病是IHCA的三个最强预测因素。与未发生IHCA的患者相比，IHCA对出院后生存的影响可持续1年，IPTW加权风险比为5.19（95%可信区间：5.06, 5.35）。脓毒症患者发生IHCA对短期和长期生存均有负面影响。住院脓毒症患者中IHCA的风险与年龄和心脏风险指数密切相关。确定的这三个危险因素可帮助临床医生识别发生IHCA风险较高的患者。
