Results:
We identified a total of 1,412,985 patients from January 2007 to
December 2017 who suffered in-hospital SCA after excluding for age ≤ 18
years, AKI and prior history of renal transplantation. Out of these
patients, about 123,962 (9.6%) patients had ESRD (please see figure 1).
Baseline characteristics of the study population are shown in table 1.
ESRD patients who suffered in-hospital SCA were younger when compared to
non-ESRD patients with in-hospital SCA (65 years vs. 69 years, p
< 0.01). Female patients were equally represented in both
groups (44.7% vs. 44.7%, p = 0.45). ESRD was less prevalent in White
patients (40.1% vs. 66.1%, p < 0.01) and more prevalent in
Blacks (36.7% vs. 18.6%, p < 0.01) and Hispanics (15% vs.
9.1%, p < 0.01). In terms of co-morbidity burden, congestive
heart failure (34.8% vs. 21.8%, p < 0.01), complicated
diabetes (32.5% vs. 8.4%, p < 0.01), hypertension (80.9%
vs. 50.4%, p < 0.01), coronary artery disease (39.4% vs.
30.8%, p < 0.01) and peripheral vascular disease (19.9% vs.
9.9%, p < 0.01) were more prevalent in ESRD patients who
sustained in-hospital SCA when compared to non-ESRD patients.
Crude and propensity matched outcomes are shown in table 2. A total of
1,035,037 (73.2%) patients died in our cohort after sustaining an
in-hospital SCA. No difference in mortality was noted in PS matched
analysis among ESRD and non-ESRD patients with in-hospital SCA (70.4%
vs. 70.7%, p = 0.45). The median LOS was 7 days (range 2-15) among ESRD
patients who survived in-hospital SCA when compared to 6 days (range
2-13) in non-ESRD patients. Overall cost of hospitalization was
80,150.5$ (range 35,009$-177,894$) in ESRD patients with in-hospital
SCA when compared to 65,297$ (range 28,195$-145,639$) in non-ESRD
patients. The utilization of invasive cardiovascular procedures such as
diagnostic coronary angiogram (7.8% vs. 10.6%, p < 0.01),
percutaneous coronary intervention (2.6% vs. 4.6%, p < 0.01)
and intra-aortic balloon pump implantation (1.7% vs. 3.4%, p
< 0.01) were lower in ESRD patients when compared to non-ESRD
patients.
Over our study period from 2007-2017, the proportion of ESRD and
non-ESRD patients who sustained in-hospital SCA was similar (please see
figure 2). In-patient mortality showed a downward trend for both ESRD
and non-ESRD patients with in-hospital SCA after an initial spike in
year 2009 (please see figure 3). Median LOS showed a stable trend over
our study years (please see figure 4).
Predictors of mortality in ESRD patients after they sustained SCA are
shown in figure 5. Advanced age (OR 1.02 per year increase, 95% CI
1.019-1.022), Black race (OR 1.127, 95% CI 1.091-1.164), chronic
pulmonary disease (OR 1.063, 95% CI 1.029-1.098), coagulopathy (OR
1.129, 95% CI 1.092-1.167), diabetes (OR 1.046, 95% CI 1.009-1.084),
hypertension (OR 1.06, 95% CI 1.025-1.096), chronic liver disease (OR
1.308, 95% CI 1.239-1.382) and peripheral vascular disease (OR 1.079,
95% CI 1.044-1.115) were independently associated with increased
mortality in ESRD patients after a SCA event.