Objective: The aim of this research was to study the factors contributing to the survival rate of in-hospital cardiac arrest (IHCA) and to determine whether the incidence density of fever (IDF) acts as a mediator. Methods: Data from patients with IHCA who survived more than 48 h were collected from 2011 to 2017. IDF was defined as the fever duration divided by the hospitalization duration, prolonged fever was defined as fever lasting for more than 5 days, and early fever was defined as an initial onset within the first 2 days of IHCA. Possible clinical variables associated with IDF were examined by linear regression, and possible clinical variables associated with survival rate were examined by univariate and multivariate analyses. IDF was investigated as a mediator of the indirect effects of the risk factors on survival. Results: In our retrospective study, the median IDF was 0, with an interquartile range from 0 to 0.42. Prolonged fever was noted in 16% (97/605) of the total, and early fever was noted in 17.2% (104/605) of the total. Linear regression results showed that positive chest X-ray, central venous catheter and Glasgow Coma Score (GCS) ≤ 8 were related to IDF. The IDF (OR: 0.36, 95% CI, 0.13-0.97, P = 0.04), prolonged fever (adjusted OR = 0.13, 95% CI, 0.06-0.29, P < 0.001), positive chest X-ray (OR: 0.67, 95% CI, 0.46-0.98, P = 0.04), central venous catheter placement (OR: 0.54, 95% CI, 0.34-0.89, P = 0.01), and endotracheal intubation (OR: 0.47, 95% CI, 0.33-0.69, P < 0.001) were also related to the negative outcome of hospital discharge after adjustment. Additionally, positive chest X-ray had a 19% effect on survival outcome through IDF as a mediator, and the indirect effect of central venous catheter mediated by IDF accounted for 10% of the total. Conclusions: A higher IDF, prolonged fever, a positive chest X-ray, the use of a central venous catheter and endotracheal intubation reduced the survival rate of these patients, and the detrimental impacts of a positive chest X-ray and the use of a central venous catheter on survival outcomes were partially mediated by IDF.
Keywords: cardiac arrest; causal mediation analysis; fever; mediator; survival rate.
Copyright © 2020 Hu, Guo, Wang, Li, Sun and Cui.
Intubation is not a marker for coma after in-hospital cardiac arrest: A retrospective study.Resuscitation. 2017 Oct;119:18-20. doi: 10.1016/j.resuscitation.2017.07.024. Epub 2017 Jul 24. Resuscitation. 2017. PMID: 28750886 Free PMC article.
Retrospective cohort study of hospital variation in airway management during in-hospital cardiac arrest and the association with patient survival: insights from Get With The Guidelines-Resuscitation.Crit Care. 2019 May 6;23(1):158. doi: 10.1186/s13054-019-2426-5. Crit Care. 2019. PMID: 31060580 Free PMC article.
[Comparisons of Clinical Effectiveness and Survival between Continuous and Interrupted Chest Compressions in Out-of-hospital Cardiac Arrest].Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2018 Aug 30;40(4):473-480. doi: 10.3881/j.issn.1000-503X.9940. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2018. PMID: 30193600 Chinese.
In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival.Intensive Care Med. 2007 Feb;33(2):237-45. doi: 10.1007/s00134-006-0326-z. Epub 2006 Sep 22. Intensive Care Med. 2007. PMID: 17019558 Review.
Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest.Cochrane Database Syst Rev. 2017 Mar 27;3(3):CD010134. doi: 10.1002/14651858.CD010134.pub2. Cochrane Database Syst Rev. 2017. PMID: 28349529 Free PMC article. Review.