Background

We studied the association between cardiorenal function and survival, neurological outcome and trends in survival after in-hospital cardiac arrest (IHCA).

Methods

We included cases aged ≥ 18 years in the Swedish Cardiopulmonary Resuscitation Registry during 2008 to 2020. The CKD-EPI equation was used to calculate estimated glomerular filtration rate (eGFR). A history of heart failure was defined according to contemporary guideline criteria. Logistic regression was used to study survival. Neurological outcome was assessed using cerebral performance category (CPC).

Results

We studied 22,819 patients with IHCA. The 30-day survival was 19.3%, 16.6%, 22.5%, 28.8%, 39.3%, 44.8% and 38.4% in cases with eGFR < 15, 15–29, 30–44, 45–59, 60–89, 90–130 and 130–150 ml/min/1.73 m², respectively. All eGFR levels below and above 90 ml/min/1.73 m² were associated with increased mortality. Probability of survival at 30 days was 62% lower in cases with eGFR < 15 ml/min/1.73 m², compared with normal kidney function. At every level of eGFR, presence of heart failure increased mortality markedly; patients without heart failure displayed higher mortality only at eGFR below 30 ml/min/1.73 m². Among survivors with eGFR < 15 ml/min/1.73 m², good neurological outcome was noted in 87.2%. Survival increased in most groups over time, but most for those with eGFR < 15 ml/min/1.73 m², and least for those with normal eGFR.

Conclusions

All eGFR levels below and above normal range are associated with increased mortality and this association is modified by the presence of heart failure. Neurological outcome is good in the majority of cases, across kidney function levels and survival is increasing.

中文翻译：

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院内心脏骤停患者的心肾功能和生存率：一项针对 22,819 例病例的全国性研究

背景

我们研究了院内心脏骤停 (IHCA) 后心肾功能与生存、神经系统结果和生存趋势之间的关系。

方法

我们在 2008 年至 2020 年期间纳入瑞典心肺复苏登记处年龄 ≥ 18 岁的病例。使用 CKD-EPI 方程计算估计的肾小球滤过率 (eGFR)。根据当代指南标准定义心力衰竭病史。逻辑回归用于研究生存率。使用脑性能类别（CPC）评估神经系统结果。

结果

我们研究了 22,819 名 IHCA 患者。在 eGFR < 15、15-29、30-44、45-59、60-89、90 的情况下，30 天生存率为 19.3%、16.6%、22.5%、28.8%、39.3%、44.8% 和 38.4%分别为–130 和 130–150 ml/min/1.73 m ²。所有低于和高于 90 ml/min/1.73 m ²的 eGFR 水平都与死亡率增加有关。与正常肾功能相比，eGFR < 15 ml/min/1.73 m ^{2的病例在 30 天的存活率降低了 62%。}在每个 eGFR 水平上，心力衰竭的存在都会显着增加死亡率；没有心力衰竭的患者仅在 eGFR 低于 30 ml/min/1.73 m ²时死亡率更高。在 eGFR < 15 ml/min/1.73 m ^{2的幸存者中}，87.2% 的患者神经系统预后良好。大多数组的存活率随着时间的推移而增加，但大多数组中 eGFR < 15 ml/min/1.73 m ²的组，而 eGFR 正常的组最少。

结论

所有低于和高于正常范围的 eGFR 水平都与死亡率增加有关，并且这种关联会因心力衰竭的存在而改变。在大多数情况下，神经系统预后良好，肾功能水平和存活率都在增加。