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Pekkarinen, P.T., Bäcklund, M., Efendijev, I. et al. Association of extracerebral organ failure with 1-year survival and healthcare-associated costs after cardiac arrest: an observational database study. Crit Care 23, 67 (2019). https://doi.org/10.1186/s13054-019-2359-z

Association of extracerebral organ failure with 1-year survival and healthcare-associated costs after cardiac arrest : an observational database study

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Author: Pekkarinen, Pirkka T.1; Bäcklund, Minna1; Efendijev, Ilmar1;
Organizations: 1Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, PB 340, 00029, Helsinki, HUS, Finland
2Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
4Division of Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
5Department of Intensive Care, Tampere University Hospital, Tampere, Finland
6Department of Anaesthesiology, University of Oulu, Oulu, Finland
7Division of Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
8University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
9Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2020040914191
Language: English
Published: Springer Nature, 2019
Publish Date: 2020-04-09
Description:

Abstract

Background: Organ dysfunction is common after cardiac arrest and associated with worse short-term outcome, but its impact on long-term outcome and treatment costs is unknown.

Methods: We used nationwide registry data from the intensive care units (ICU) of the five Finnish university hospitals to evaluate the association of 24-h extracerebral Sequential Organ Failure Assessment (24h-EC-SOFA) score with 1-year survival and healthcare-associated costs after cardiac arrest. We included adult cardiac arrest patients treated in the participating ICUs between January 1, 2003, and December 31, 2013. We acquired the confirmed date of death from the Finnish Population Register Centre database and gross 1-year healthcare-associated costs from the hospital billing records and the database of the Finnish Social Insurance Institution.

Results: A total of 5814 patients were included in the study, and 2401 were alive 1 year after cardiac arrest. Median (interquartile range (IQR)) 24h-EC-SOFA score was 6 (5–8) in 1-year survivors and 7 (5–10) in non-survivors. In multivariate regression analysis, adjusting for age and prior independency in self-care, the 24h-EC-SOFA score had an odds ratio (OR) of 1.16 (95% confidence interval (CI) 1.14–1.18) per point for 1-year mortality.

Median (IQR) healthcare-associated costs in the year after cardiac arrest were €47,000 (€28,000–75,000) in 1-year survivors and €12,000 (€6600–25,000) in non-survivors. In a multivariate linear regression model adjusting for age and prior independency in self-care, an increase of one point in the 24h-EC-SOFA score was associated with an increase of €170 (95% CI €150–190) in the cost per day alive in the year after cardiac arrest. In the same model, an increase of one point in the 24h-EC-SOFA score was associated with an increase of €4400 (95% CI €3300–5500) in the total healthcare-associated costs in 1-year survivors.

Conclusions: Extracerebral organ dysfunction is associated with long-term outcome and gross healthcare-associated costs of ICU-treated cardiac arrest patients. It should be considered when assessing interventions to improve outcomes and optimize the use of resources in these patients.

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Series: Critical care
ISSN: 1364-8535
ISSN-E: 1875-7081
ISSN-L: 1364-8535
Volume: 23
Article number: 67
DOI: 10.1186/s13054-019-2359-z
OADOI: https://oadoi.org/10.1186/s13054-019-2359-z
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Subjects:
Cardiac arrest
Cost of care
Cost-effectiveness
IHCA
Multiple organ failure
OHCA
Organ failure
Outcome
Post cardiac arrest syndrome
SOFA
Article
Funding: Orion Research Foundation sr., Finska Läkaresällskapet, Viipurin tuberkuloosisäätiö, Svenska Kulturfonden, Medicinska Understödsföreningen Liv and Hälsa, Maud Kuistilan Säätiö, Eemil Aaltosen Säätiö, Ella and Georg Ehrnroothin Säätiö, Suomalais-Norjalainen Lääketieteen Säätiö, Suomen Lääketieteen Säätiö, Maire Taposen Säätiö, and Helsinki University Hospital (state funding: VTRTYH2014221).
Copyright information: © The Author(s). 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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