Association between chronic liver disease and clinical outcomes in out-of-hospital cardiac arrest

Liver protects neuron viability and electrocortical activity in post-cardiac arrest brain injury

Brain injury is the leading cause of mortality among patients who survive cardiac arrest (CA). Clinical studies have shown that the presence of post-CA hypoxic hepatitis or pre-CA liver disease is associated with increased mortality and inferior neurological recovery. In our in vivo global cerebral ischemia model, we observed a larger infarct area, elevated tissue injury scores, and increased intravascular CD45+ cell adhesion in reperfused brains with simultaneous hepatic ischemia than in those without it. In the ex vivo brain normothermic machine perfusion (NMP) model, we demonstrated that addition of a functioning liver to the brain NMP circuit significantly reduced post-CA brain injury, increased neuronal viability, and improved electrocortical activity. Furthermore, significant alterations were observed in both the transcriptome and metabolome in the presence or absence of hepatic ischemia. Our study highlights the crucial role of the liver in the pathogenesis of post-CA brain injury.

Age-adjusted Charlson Comorbidity Index as effective predictor for in-hospital mortality of patients with cardiac arrest: a retrospective study

BACKGROUND

Cardiac arrest is currently one of the leading causes of mortality in clinical practice, and the Charlson Comorbidity Index (CCI) is widely utilized to assess the severity of comorbidities. We aimed to evaluate the relationship between the age-adjusted CCI score and in-hospital mortality in intensive care unit (ICU) patients with the diagnosis of cardiac arrest, which is important but less explored previously.

METHODS

This was a retrospective study including patients aged over 18 years from the MIMIC-IV database. We calculated the age-adjusted CCI using age information and ICD codes. The univariate analysis for varied predictors' differences between the survival and the non-survival groups was performed. In addition, a multiple factor analysis was conducted based on logistic regression analysis with the primary result set as hospitalization death. An additional multivariate regression analysis was conducted to estimate the influence of hospital and ICU stay.

RESULTS

A total of 1772 patients were included in our study, with median age of 66, among which 705 (39.8%) were female. Amongst these patients, 963 (54.3%) died during the hospitalization period. Patients with higher age-adjusted CCI scores had a higher likelihood of dying during hospitalization (P < 0.001; OR: 1.109; 95% CI: 1.068-1.151). With the age-adjusted CCI incorporated into the predictive model, the area under the receiver operating characteristic curve was 0.794 (CI: 0.773-0.814), showing that the prediction model is effective. Additionally, patients with higher age-adjusted CCI scores stayed longer in the hospital (P = 0.026, 95% CI: 0.056-0.896), but there was no significant difference between patients with varied age-adjusted CCI scores on the days of ICU stay.

CONCLUSION

The age-adjusted CCI is a valid indicator to predict death in ICU patients with cardiac arrest, which can offer enlightenment for both theory literatures and clinical practice.