Kevin Roedl1, Alexander O Spiel2, Alexander Nürnberger3, Thomas Horvatits4, Andreas Drolz5, Pia Hubner6, Alexandra-Maria Warenits7, Fritz Sterz8, Harald Herkner9, Valentin Fuhrmann10. 1. Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria. Electronic address: k.roedl@uke.de. 2. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria. Electronic address: alexander.spiel@meduniwien.ac.at. 3. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria. Electronic address: alexander.nuernberger@meduniwien.ac.at. 4. Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria. Electronic address: t.horvatits@uke.de. 5. Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria. Electronic address: a.drolz@uke.de. 6. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria. Electronic address: pia.hubner@meduniwien.ac.at. 7. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria. Electronic address: alexandra-maria.warenits@meduniwien.ac.at. 8. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria. Electronic address: fritz.sterz@meduniwien.ac.at. 9. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria. Electronic address: herald.herkner@meduniwien.ac.at. 10. Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria. Electronic address: vfuhrmann@outlook.de.
Abstract
BACKGROUND: Hypoxic liver injury (HLI) is a frequent and life-threatening complication in critically ill patients that occurs in up to ten percent of critically ill patients. However, there is a lack of data on HLI following cardiac arrest and its clinical implications on outcome. Aim of this study was to investigate incidence, outcome and functional outcome of patients with HLI after in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). METHODS: We conducted an analysis of a cardiac arrest registry data over a 7-year period. All patients with non-traumatic OHCA and IHCA with return of spontaneous circulation (ROSC) treated at the emergency department of a tertiary care hospital were included in the study. HLI was defined according to established criteria. Predictors of HLI, occurrence, clinical and neurological outcome were assessed using multivariable regression. RESULTS: Out of 1068 patients after IHCA and OHCA with ROSC, 219 (21%) patients developed HLI. Rate of HLI did not differ significantly in IHCA and OHCA patients. Multivariate regression analysis identified time-to-ROSC [OR 1.18, 95% CI (1.01-1.38); p < 0.05], presence of cardiac failure [OR 2.57, 95% CI (1.65-4.01); p < 0.001] and Charlson comorbidity index [OR 0.83, 95% CI (0.72-0.95); p < 0.01] as independent predictors for occurrence of HLI. Good functional outcome was significantly lower in patients suffering from HLI after 28-days (35% vs. 48%, p < 0.001) and 1-year (34% vs. 44%, p < 0.001). Occurrence of HLI was associated with unfavourable neurological outcome [OR 1.74, 95% CI (1.16-2.61); p < 0.01] in multivariate regression analysis. CONCLUSION: New onset of HLI is a frequent finding after IHCA and OHCA. HLI is associated with increased mortality, unfavourable neurological and overall outcome.
BACKGROUND:Hypoxic liver injury (HLI) is a frequent and life-threatening complication in critically illpatients that occurs in up to ten percent of critically illpatients. However, there is a lack of data on HLI following cardiac arrest and its clinical implications on outcome. Aim of this study was to investigate incidence, outcome and functional outcome of patients with HLI after in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). METHODS: We conducted an analysis of a cardiac arrest registry data over a 7-year period. All patients with non-traumatic OHCA and IHCA with return of spontaneous circulation (ROSC) treated at the emergency department of a tertiary care hospital were included in the study. HLI was defined according to established criteria. Predictors of HLI, occurrence, clinical and neurological outcome were assessed using multivariable regression. RESULTS: Out of 1068 patients after IHCA and OHCA with ROSC, 219 (21%) patients developed HLI. Rate of HLI did not differ significantly in IHCA and OHCA patients. Multivariate regression analysis identified time-to-ROSC [OR 1.18, 95% CI (1.01-1.38); p < 0.05], presence of cardiac failure [OR 2.57, 95% CI (1.65-4.01); p < 0.001] and Charlson comorbidity index [OR 0.83, 95% CI (0.72-0.95); p < 0.01] as independent predictors for occurrence of HLI. Good functional outcome was significantly lower in patients suffering from HLI after 28-days (35% vs. 48%, p < 0.001) and 1-year (34% vs. 44%, p < 0.001). Occurrence of HLI was associated with unfavourable neurological outcome [OR 1.74, 95% CI (1.16-2.61); p < 0.01] in multivariate regression analysis. CONCLUSION: New onset of HLI is a frequent finding after IHCA and OHCA. HLI is associated with increased mortality, unfavourable neurological and overall outcome.
Authors: Shin Young Park; Min Joung Kim; Incheol Park; Ha Yan Kim; Myeongjee Lee; Yoo Seok Park; Sung Phil Chung Journal: J Clin Med Date: 2022-03-04 Impact factor: 4.241
Authors: Yun Im Lee; Min Goo Kang; Ryoung-Eun Ko; Taek Kyu Park; Chi Ryang Chung; Yang Hyun Cho; Kyeongman Jeon; Gee Young Suh; Jeong Hoon Yang Journal: J Clin Med Date: 2020-09-16 Impact factor: 4.241
Authors: Kevin Roedl; Dominik Jarczak; Andreas Drolz; Dominic Wichmann; Olaf Boenisch; Geraldine de Heer; Christoph Burdelski; Daniel Frings; Barbara Sensen; Axel Nierhaus; Marc Lütgehetmann; Stefan Kluge; Valentin Fuhrmann Journal: Ann Intensive Care Date: 2021-03-15 Impact factor: 6.925
Authors: Kevin Roedl; Gerold Söffker; Dominic Wichmann; Olaf Boenisch; Geraldine de Heer; Christoph Burdelski; Daniel Frings; Barbara Sensen; Axel Nierhaus; Dirk Westermann; Stefan Kluge; Dominik Jarczak Journal: J Clin Med Date: 2021-05-19 Impact factor: 4.241