Outcome of in- and out-of-hospital cardiac arrest survivors with liver cirrhosis

Abstract

BackgroundOrgan failure increases mortality in patients with liver cirrhosis. Data about resuscitated cardiac arrest patients with liver cirrhosis are missing. This study aims to assess aetiology, survival and functional outcome in patients after successful cardiopulmonary resuscitation (CPR) with and without liver cirrhosis.MethodsAnalysis of prospectively collected cardiac arrest registry data of consecutively hospital-admitted patients following successful CPR was performed. Patient’s characteristics, admission diagnosis, severity of disease, course of disease, short- and long-term mortality as well as functional outcome were assessed and compared between patients with and without cirrhosis.ResultsOut of 1068 patients with successful CPR, 47 (4%) had liver cirrhosis. Acute-on-chronic liver failure (ACLF) was present in 33 (70%) of these patients on admission, and four patients developed ACLF during follow-up. Mortality at 1 year was more than threefold increased in patients with liver cirrhosis (OR 3.25; 95% CI 1.33–7.96). Liver cirrhosis was associated with impaired neurological outcome (OR for a favourable cerebral performance category: 0.13; 95% CI 0.04–0.36). None of the patients with Child–Turcotte–Pugh (CTP) C cirrhosis survived 28 days with good neurological outcome. Overall nine (19%) patients with cirrhosis survived 28 days with good neurological outcome. All patients with ACLF grade 3 died within 28 days.ConclusionCardiac arrest survivors with cirrhosis have worse outcome than those without. Although one quarter of patients with liver cirrhosis survived longer than 28 days after successful CPR, patients with CTP C as well as advanced ACLF did not survive 28 days with good neurological outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0322-1) contains supplementary material, which is available to authorized users.

Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis

“…Mortality in our critically ill patients with cirrhosis was high (>50% died within 1 year following ICU admission), which is comparable to earlier studies in this field . In keeping with the literature, lactate levels were associated with poor outcome in our patients with cirrhosis (Fig.…”

“…SOFA, median (IQR) 11 (7)(8)(9)(10)(11)(12)(13)(14) CLIF-SOFA, median (IQR) 12 (8)(9)(10)(11)(12)(13)(14)(15) CLIF-C ACLF score, median (IQR) 53.6 (45.0-61. (P < 0.01 for all).…”

“…Mortality rates in patients with cirrhosis treated at the ICU range between 40% and 60% . Different scoring systems have been developed in order to assess prognosis in patients with cirrhosis and ACLF .…”

Outcomes of in‐hospital cardiopulmonary resuscitation for patients with end‐stage liver disease

“…Prior studies have demonstrated that patients with shockable rhythms have higher odds of survival after receipt of in‐hospital CPR compared to those with non‐shockable rhythms . Hospitalized patients with cirrhosis are less likely to have a cardiac aetiology of their cardiac arrests and are more likely to have an initial non‐shockable rhythm of pulseless electrical activity or asystole . Unfortunately, we do not have specific data on the aetiology of cardiac arrest in this cohort.…”

In-Hospital Outcomes of Patients With Pulmonary Hypertension and Cirrhosis: A 6-Year Population Cohort Study of Over One Million Patients

“…Of all cardiac arrests in patients with pulmonary hypertension, 50% are due to the progression of the underlying disease, so this complication must be prevented from occurring in the first place due to the very low chance of recovery [ 15 ]. Similarly for patients with cirrhosis, cardiac arrest is a marker of a very poor prognosis; in one study, only 19% of these patients survived and of these patients, most had very poor neurological recovery 1 month after surviving cardiac arrest [ 16 ].…”