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

Objectives: Out-of-hospital cardiac arrest (OHCA) and chronic liver disease (CLD) are global health issues. The purpose of this study is to evaluate the association between chronic liver disease and clinical outcomes in OHCA.

Methods: A retrospective observation study, using a nationwide population-based OHCA registry, was conducted. Adult patients with cardiac OHCAs who were treated by emergency medical service (EMS) providers between January 2013 and December 2015 were screened. The main exposure was the status of chronic liver disease that had been diagnosed before OHCA, categorized into three groups: no CLD, CLD without cirrhosis, and CLD with cirrhosis. Multivariable logistic regression analysis for survival and neurologic recovery were conducted to calculate the adjusted odds ratio (AOR) and confidence intervals (CIs). Interaction analysis for age, gender were performed and sensitivity analysis by imputation for main exposure missing was also.

Result: A total of 8844 eligible OHCA patients were enrolled. There were 361 (4.1%) patients in the CLD without cirrhosis group and 1323 (15%) patients in the CLD with cirrhosis group. Compared to no CLD group, CLD with cirrhosis group was less likely to have favorable outcomes for good neurological recovery and survival to discharge. Patients with CLD but without cirrhosis showed similar associations in neurologic recovery and survival with those without CLD. In multivariable logistic regression analysis, the AOR and 95% CIs for good neurological outcome and survival to discharge were as below; good neurological outcome - 1.07 (0.70-1.64) for CLD without cirrhosis, 0.08 (0.04-0.16) for CLD with cirrhosis, survival to discharge - 1.01 (0.70-1.45) for CLD without cirrhosis, 0.13 (0.08-0.20) for CLD with cirrhosis. Same trends of association were demonstrated in interaction and imputation analysis.

Conclusion: OHCA patients with liver cirrhosis showed poor clinical outcomes and CLD had no negative association unless they progressed to cirrhotic status.