Abstract Body: Introduction
Cardiac arrest (CA) has been linked with worse outcomes in patients with chronic medical conditions such as chronic obstructive pulmonary disease, chronic kidney disease, diabetes mellitus, hypertension, and coronary artery disease. Autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) have been linked to increased risk of cardiovascular diseases, but their effect on the outcome of CA is not well studied.
Aim
This study aimed to evaluate the effect of SLE and RA on the outcomes of admitted CA patients.
Methodology
We identified all adult CA hospitalizations in the US between 2016 and 2020 using the National Inpatient Sample database and categorized them based on RA and SLE diagnoses. We applied logistic regression analysis to study the effects of SLE or RA diagnosis on CA outcomes, with a p-value threshold of 0.01.
Results:
A total of 1,099,235 adults were admitted with CA between 2016 to 2020. There were 5745 and 16920 patients with SLE and RA diagnoses among CA hospitalizations, respectively. Among CA patients, the mean age was 54.4 vs. 70.5 years among SLE and RA groups. CA patients with SLE diagnosis had 18% higher odds of in-hospital mortality (OR: 1.18 [1.04-1.34]; p=0.008), similar to those with RA diagnosis (OR:1.16 [1.08-1.24]; p<0.001) when compared to those without SLE or RA. Unlike RA, the SLE effect persisted (AOR:1.44 [1.26-1.64]; p< 0.001) after adjusting for sociodemographic factors (such as age and sex) and other co-morbidities (for RA, AOR: 1.09 [1.01-1.18]; p=0.023).
Further analysis to determine if this reported mortality effect of SLE on CA patients is explainable by a general SLE mortality revealed that the interaction of SLE and CA is associated with higher mortality in the broader adult patient population, independent of CA or SLE alone (OR:1.52 [1.34-1.71]; P<0.001). This synergistic effect persisted after controlling for comorbidities and sociodemographic factors (AOR: 1.9 [1.66-2.27]; p< 0.001).
RA or SLE diagnosis were not associated with acute heart failure, cardiogenic shock, and acute kidney injury outcomes in CA patients.
Conclusion:
Our findings suggest an adverse clinical interaction between SLE and CA that is independent of CA or SLE alone, and also independent of other comorbidities and sociodemographic factors. More research is needed to further explore the potential mechanisms involved.