TY - JOUR
T1 - Comorbidity burden is not associated with higher mortality after out-of-hospital cardiac arrest
AU - Winther-Jensen, Matilde
AU - Kjaergaard, Jesper
AU - Nielsen, Niklas
AU - Kuiper, Michael
AU - Friberg, Hans
AU - Søholm, Helle
AU - Thomsen, Jakob Hartvig
AU - Frydland, Martin
AU - Hassager, Christian
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Objectives. We investigated whether comorbidity burden of comatose survivors of out-of-hospital cardiac arrest (OHCA) affects outcome and if comorbidity modifies the effect of target temperature management (TTM) on final outcome. Design. The TTM trial randomized 939 patients to 24 h of TTM at either 33 or 36 °C with no difference regarding mortality and neurological outcome. This post-hoc study of the TTM-trial formed a modified comorbidity index (mCI), based on available comorbidities from the Charlson comorbidity index (CCI). Results. Bystander cardiopulmonary resuscitation (CPR) decreased with higher comorbidity group, p = 0.01. Comorbidity groups were univariately associated with higher mortality compared to mCI0 (HR mCI1 : 1.55, CI: 1.25–1.93, p < 0.001, HR mCI2 : 2.01, CI: 1.55–2.62, p < 0.001, HR mCI ≥ 3 : 2.16, CI: 1.57–2.97, p < 0.001). When adjusting for confounders there was a consistent, nonsignificant association between level of comorbidity and mortality (HRm C11 : 1.17, CI: 0.92–1.48, p = 0.21, HR mCI2 : 1.28, CI: 0.96–1.71, p = 0.10, HR mCI ≥ 3 : 1.37, CI: 0.97–1.95, p = 0.08). There was no interaction between comorbidity burden and level of TTM on outcome, p = 0.61. Conclusion. Comorbidity burden was associated with higher mortality following OHCA, but when adjusting for confounders, the influence was no longer significant. The association between mCI and mortality was not modified by TTM. Comorbidity burden is associated with lower rates of bystander cardiopulmonary resuscitation after OHCA.
AB - Objectives. We investigated whether comorbidity burden of comatose survivors of out-of-hospital cardiac arrest (OHCA) affects outcome and if comorbidity modifies the effect of target temperature management (TTM) on final outcome. Design. The TTM trial randomized 939 patients to 24 h of TTM at either 33 or 36 °C with no difference regarding mortality and neurological outcome. This post-hoc study of the TTM-trial formed a modified comorbidity index (mCI), based on available comorbidities from the Charlson comorbidity index (CCI). Results. Bystander cardiopulmonary resuscitation (CPR) decreased with higher comorbidity group, p = 0.01. Comorbidity groups were univariately associated with higher mortality compared to mCI0 (HR mCI1 : 1.55, CI: 1.25–1.93, p < 0.001, HR mCI2 : 2.01, CI: 1.55–2.62, p < 0.001, HR mCI ≥ 3 : 2.16, CI: 1.57–2.97, p < 0.001). When adjusting for confounders there was a consistent, nonsignificant association between level of comorbidity and mortality (HRm C11 : 1.17, CI: 0.92–1.48, p = 0.21, HR mCI2 : 1.28, CI: 0.96–1.71, p = 0.10, HR mCI ≥ 3 : 1.37, CI: 0.97–1.95, p = 0.08). There was no interaction between comorbidity burden and level of TTM on outcome, p = 0.61. Conclusion. Comorbidity burden was associated with higher mortality following OHCA, but when adjusting for confounders, the influence was no longer significant. The association between mCI and mortality was not modified by TTM. Comorbidity burden is associated with lower rates of bystander cardiopulmonary resuscitation after OHCA.
KW - Journal Article
U2 - 10.1080/14017431.2016.1210212
DO - 10.1080/14017431.2016.1210212
M3 - Journal article
C2 - 27385408
SN - 1401-7458
VL - 50
SP - 305
EP - 310
JO - Scandinavian Cardiovascular Journal, Supplement
JF - Scandinavian Cardiovascular Journal, Supplement
IS - 5-6
ER -