Neha Panchagnula
Texas Tech University Health Sciences Center at the Permian Basin
Odessa, Texas
Disclosure information not submitted.
John Garza, PhD
Assistant Professor
University of Texas Permian Basin, United States
Disclosure information not submitted.
Thao Dang, MD
Resident, Internal Medicine
n/a
Odessa, Texas, United States
Disclosure information not submitted.
Hina Tariq, MD
Resident, Internal Medicine
n/a
Odessa, Texas, United States
Disclosure information not submitted.
Lavi Oud, MD
Professor
Texas Tech University Health Sciences Center
Odessa, Texas, United States
Disclosure information not submitted.
Title: Epidemiology and Outcomes of In-Hospital Cardiac Arrest in Sepsis: a Population-Based Cohort Study
Introduction: Sepsis is an underlying condition in up to 27% of in-hospital cardiac arrest (IHCA) patients, with worse short-term outcomes in this subgroup than among non-septic patients. However, data on the epidemiology and outcomes of IHCA in sepsis are limited due to lack of population-level studies focusing specifically on sepsis and use of non-standardized sepsis definitions.
Methods: We used the Texas Inpatient Public Use Data File to identify sepsis hospitalizations aged ≥18 years during 2014-2017. Sepsis was identified using “explicit” ICD-9 and ICD-10 codes for severe sepsis (995.92, R65.20) and for septic shock (785.52, R65.21). Cardiopulmonary resuscitation was identified using ICD-9 and ICD-10 codes 99.60, 99.63, & 5A12012, excluding those with a principal diagnosis of cardiac arrest. Multilevel multivariable logistic regression was used to examine factors associated with hospital survival and survival trends. Logistic regression was used to examine trends of IHCA rates.
Results: Among 282,525 sepsis hospitalizations, 11,905 (4.2%) had IHCA. IHCA occurred in 12.7% (95% CI 12.4-12.9) of terminal sepsis hospitalizations, with the rate rising between 2014 and 2017 from 10.6% to 15.0%, respectively (odds ratio 1.12 [95% CI 1.09-1.14]). The rate of IHCA was 3.6/1,000 hospital days [95% CI 3.5-3.7]. Hospital survival of IHCA was 30.9% [95% CI 29.9-31.9] overall, but decreased from 48.6% to 23.8% between 2014 and 2017. Hospital survival was lower among females (adjusted odds ratio [aOR] 0.87 [95% CI 0.80-0.95]), Blacks (aOR 0.79 [95% CI 0.70-0.90]), the uninsured (aOR 0.80 [95% CI 0.66-0.97]), & decreased over time (aOR 0.71/year [95% CI 0.69-0.74]). The burden of comorbid conditions (Deyo comorbidity index aOR 1.01 [95% CI 0.97-1.04]) and shockable rhythm (aOR 0.87 [95% CI 0.74-1.02]) were not associated with survival.
Conclusions: Resuscitation of IHCA in sepsis was performed more selectively than that reported in the general population, but its rate rose over time. Hospital survival decreased substantially over time, contrasting opposite trends in the general population, with outcome disparities involving race, gender, and health insurance domains. Further studies are needed to explore the factors underlying these observations, in order to inform efforts to improve outcomes of sepsis-associated IHCA.