Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.
BMJ Open. 2024 Jul 15;14(7):e080710. doi: 10.1136/bmjopen-2023-080710.
It has been estimated that 80% of cases of out-of-hospital cardiac arrest (OHCA) are due to cardiac causes. It is well-documented that diabetes is a risk factor for conditions associated with sudden cardiac arrest. Type 1 diabetes (T1D) displays a threefold to fivefold increased risk of cardiovascular disease and death compared with the general population.
This study aims to assess the characteristics and survival outcomes of individuals with and without T1D who experienced an OHCA. : A registry-based nationwide observational study with two cohorts, patients with T1D and patients without T1D. : All emergency medical services and hospitals in Sweden were included in the study.
Using the Swedish Cardiopulmonary Resuscitation Registry, we enrolled 54 568 cases of OHCA where cardiopulmonary resuscitation was attempted between 2010 and 2020. Among them, 448 patients with T1D were identified using International Classification of Diseases-code: E10.
Survival analysis was performed using Kaplan-Meier and logistic regression. Multiple regression was adjusted for age, sex, cause of arrest, prevalence of T1D and time to cardiopulmonary resuscitation.
The outcomes were discharge status (alive vs dead), 30 days survival and neurological outcome at discharge.
There were no significant differences in patients discharged alive with T1D 37.3% versus, 46% among cases without T1D. There was also no difference in neurological outcome. Kaplan-Meier curves yielded no significant difference in long-term survival. Multiple regression showed no significant association with survival after accounting for covariates, OR 0.99 (95% CI 0.96 to 1.02), p value=0.7. Baseline characteristics indicate that patients with T1D were 5 years younger at OHCA occurrence and had proportionally fewer cases of heart disease as the cause of arrest (57.6% vs 62.7%).
We conclude, with the current sample size, that there is no statistically significant difference in long-term or short-term survival between patients with and without T1D following OHCA.
据估计，80%的院外心脏骤停（OHCA）病例是由心脏原因引起的。糖尿病是与心搏骤停相关的疾病的一个风险因素，这一点已得到充分证实。与一般人群相比，1 型糖尿病（T1D）的心血管疾病和死亡风险增加了 3 到 5 倍。
本研究旨在评估患有和不患有 T1D 的 OHCA 患者的特征和生存结局。
这是一项基于登记的全国性观察性研究，分为两个队列，即患有 T1D 的患者队列和不患有 T1D 的患者队列。研究纳入了 2010 年至 2020 年期间尝试心肺复苏的 54568 例 OHCA 患者。其中，通过国际疾病分类代码 E10 确定了 448 例 T1D 患者。
Kaplan-Meier 和逻辑回归分析显示，T1D 患者出院时存活的比例（37.3%）与无 T1D 患者（46%）无显著差异。两组患者的 30 天生存率和出院时的神经功能结局也无显著差异。Kaplan-Meier 曲线显示，两组患者的长期生存率也无显著差异。多因素回归分析显示，在校正了年龄、性别、心搏骤停原因、T1D 患病率和心肺复苏开始时间等混杂因素后，T1D 与生存之间无显著关联，OR 0.99（95%CI 0.96 至 1.02），p 值=0.7。基线特征表明，T1D 患者 OHCA 发生时的年龄比无 T1D 患者小 5 岁，且心脏病作为心搏骤停原因的比例较低（57.6%比 62.7%）。
在目前的样本量下，我们的结论是，T1D 患者和非 T1D 患者在 OHCA 后长期或短期生存方面没有统计学上的显著差异。
