This article is more than 5 years old. Information may no longer be current.

Cirrhosis associated with higher risk for mortality following cardiac arrest

Patients with cirrhosis have a higher risk for mortality following in-hospital cardiac arrest, compared with patients without cirrhosis, according to results of a retrospective-prospective study.

“Patients with decompensated cirrhosis are routinely admitted to the hospital and impact in-hospital mortality,” Megan E. Reinders, MD, from the University of California, San Diego, and colleagues wrote. “The main causes of in-hospital cardiac arrest in patients with cirrhosis included bleeding, sepsis and respiratory failure, all of which are potentially preventable.”

The researchers reviewed the etiology data of 954 patients who experienced in-hospital cardiac arrest between July 2005 and April 2016. Mean patient age was 59.3 years and 63.7% were men. Eighty-eight patients had cirrhosis.

Patients with cirrhosis were younger (53.9 vs. 59.9 years; P < .0001), more likely to experience a cardiac arrest outside the ICU setting (78.4% vs. 61.2%; P = .0015) and had a higher mortality rate following cardiac arrest (86.4% vs. 64.3%; P < .0001), compared with those without cirrhosis.

Regarding the higher mortality rate, patients with cirrhosis had an odds ratio of 3.51 (95% CI, 1.88-6.56) vs. those without cirrhosis. This remained significant after adjustment for age, sex and location, time, day and rhythm characteristics of cardiac arrest (OR = 3.9; 95% CI, 2.06-7.36).

The most common cause of cardiac arrest among patients with cirrhosis included circulatory failure from bleeding (25%) and sepsis (18.2%), respiratory failure (37.5%), and dysrhythmias such as primary ventricular fibrillation or vagal events (12.5%).

Compared with patients without cirrhosis, those with cirrhosis were more likely to have cardiac arrest due to circulatory causes (46.6% vs. 34.6%; P = .0275).

“These data suggest that patients with cirrhosis should have a lower threshold for transfer to the ICU, especially in the setting of suspected bleeding, SIRS/sepsis or respiratory distress,” the researchers concluded. “These data are novel and provocative and if validated may help us develop specific care pathways that continue to promote early recognition of deterioration, prompt resuscitation for bleeding, early initiation of antibiotics for sepsis and early intubation in patients with cirrhosis to reduce in-hospital mortality due to liver disease.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.