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Comorbidity burden is not associated with higher mortality after out-of-hospital cardiac arrest*

Winther-Jensen, Matilde ; Kjaergaard, Jesper ; Nielsen, Niklas LU ; Kuiper, Michael ; Friberg, Hans LU ; Søholm, Helle ; Thomsen, Jakob Hartvig ; Frydland, Martin and Hassager, Christian (2016) In Scandinavian Cardiovascular Journal 50(5-6). p.305-310
Abstract

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 (HRmCI1:... (More)

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 (HRmCI1: 1.55, CI: 1.25–1.93, p mCI2: 2.01, CI: 1.55–2.62, p mCI ≥ 3: 2.16, CI: 1.57–2.97, p C11: 1.17, CI: 0.92–1.48, p = 0.21, HRmCI2: 1.28, CI: 0.96–1.71, p = 0.10, HRmCI ≥ 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.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
comorbidity, neurological outcome, Out-of-hospital cardiac arrest, target temperature management
in
Scandinavian Cardiovascular Journal
volume
50
issue
5-6
pages
305 - 310
publisher
Taylor & Francis
external identifiers
  • scopus:84980022394
  • pmid:27385408
  • wos:000390105700009
ISSN
1401-7431
DOI
10.1080/14017431.2016.1210212
language
English
LU publication?
yes
id
51613091-8fb1-4bfc-b080-1932328a24db
date added to LUP
2016-08-15 11:11:56
date last changed
2025-01-12 09:38:08
@article{51613091-8fb1-4bfc-b080-1932328a24db,
  abstract     = {{<p>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<sub>mCI1</sub>: 1.55, CI: 1.25–1.93, p mCI2: 2.01, CI: 1.55–2.62, p mCI ≥ 3: 2.16, CI: 1.57–2.97, p C11: 1.17, CI: 0.92–1.48, p = 0.21, HR<sub>mCI2</sub>: 1.28, CI: 0.96–1.71, p = 0.10, HR<sub>mCI ≥ 3</sub>: 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.</p>}},
  author       = {{Winther-Jensen, Matilde and Kjaergaard, Jesper and Nielsen, Niklas and Kuiper, Michael and Friberg, Hans and Søholm, Helle and Thomsen, Jakob Hartvig and Frydland, Martin and Hassager, Christian}},
  issn         = {{1401-7431}},
  keywords     = {{comorbidity; neurological outcome; Out-of-hospital cardiac arrest; target temperature management}},
  language     = {{eng}},
  number       = {{5-6}},
  pages        = {{305--310}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Cardiovascular Journal}},
  title        = {{Comorbidity burden is not associated with higher mortality after out-of-hospital cardiac arrest<sup>*</sup>}},
  url          = {{http://dx.doi.org/10.1080/14017431.2016.1210212}},
  doi          = {{10.1080/14017431.2016.1210212}},
  volume       = {{50}},
  year         = {{2016}},
}