Postarrest Steroid Use May Improve Outcomes of Cardiac Arrest Survivors

Min Shan Tsai, Po Ya Chuang, Chien Hua Huang, Chao Hsiun Tang, Ping Hsun Yu, Wei Tien Chang, Wen Jone Chen

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To evaluate the ramifications of steroid use during postarrest care. DESIGN: Retrospective observational population-based study enrolled patients during years 2004-2011 with 1-year follow-up. SETTING: Taiwan National Health Insurance Research Database. PATIENTS: Adult nontraumatic cardiac arrest patients in the emergency department, who survived to admission. INTERVENTIONS: These patients were classified into the steroid and nonsteroid groups based on whether steroid was used or not during hospitalization. A propensity score was used to match patient underlying characteristics, steroid use prior to cardiac arrest, the vasopressors, and shockable rhythm during cardiopulmonary resuscitation, hospital level, and socioeconomic status. MEASUREMENTS AND MAIN RESULTS: There were 5,445 patients in each group after propensity score matching. A total of 4,119 patients (75.65%) in the steroid group died during hospitalization, as compared with 4,403 patients (80.86%) in the nonsteroid group (adjusted hazard ratio, 0.74; 95% CI, 0.70-0.77; p < 0.0001). The mortality rate at 1 year was significantly lower in the steroid group than in the nonsteroid group (83.54% vs 87.77%; adjusted hazard ratio, 0.73; 95% CI, 0.70-0.76; p < 0.0001). Steroid use during hospitalization was associated with survival to discharge, regardless of age, gender, underlying diseases (diabetes mellitus, chronic obstructive pulmonary disease, asthma), shockable rhythm, and steroid use prior to cardiac arrest. CONCLUSIONS: In this retrospective observational study, postarrest steroid use was associated with better survival to hospital discharge and 1-year survival.

Original languageEnglish
Pages (from-to)167-175
Number of pages9
JournalCritical Care Medicine
Volume47
Issue number2
DOIs
Publication statusPublished - Feb 1 2019

Fingerprint

Heart Arrest
Survivors
Steroids
Propensity Score
Hospitalization
Survival
Cardiopulmonary Resuscitation
National Health Programs
Taiwan
Social Class
Chronic Obstructive Pulmonary Disease
Observational Studies
Hospital Emergency Service
Diabetes Mellitus
Asthma
Retrospective Studies
Databases
Mortality
Research
Population

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Tsai, M. S., Chuang, P. Y., Huang, C. H., Tang, C. H., Yu, P. H., Chang, W. T., & Chen, W. J. (2019). Postarrest Steroid Use May Improve Outcomes of Cardiac Arrest Survivors. Critical Care Medicine, 47(2), 167-175. https://doi.org/10.1097/CCM.0000000000003468

Postarrest Steroid Use May Improve Outcomes of Cardiac Arrest Survivors. / Tsai, Min Shan; Chuang, Po Ya; Huang, Chien Hua; Tang, Chao Hsiun; Yu, Ping Hsun; Chang, Wei Tien; Chen, Wen Jone.

In: Critical Care Medicine, Vol. 47, No. 2, 01.02.2019, p. 167-175.

Research output: Contribution to journalArticle

Tsai, MS, Chuang, PY, Huang, CH, Tang, CH, Yu, PH, Chang, WT & Chen, WJ 2019, 'Postarrest Steroid Use May Improve Outcomes of Cardiac Arrest Survivors', Critical Care Medicine, vol. 47, no. 2, pp. 167-175. https://doi.org/10.1097/CCM.0000000000003468
Tsai, Min Shan ; Chuang, Po Ya ; Huang, Chien Hua ; Tang, Chao Hsiun ; Yu, Ping Hsun ; Chang, Wei Tien ; Chen, Wen Jone. / Postarrest Steroid Use May Improve Outcomes of Cardiac Arrest Survivors. In: Critical Care Medicine. 2019 ; Vol. 47, No. 2. pp. 167-175.
@article{9191c038bf5b4594b26beb482ed03745,
title = "Postarrest Steroid Use May Improve Outcomes of Cardiac Arrest Survivors",
abstract = "OBJECTIVES: To evaluate the ramifications of steroid use during postarrest care. DESIGN: Retrospective observational population-based study enrolled patients during years 2004-2011 with 1-year follow-up. SETTING: Taiwan National Health Insurance Research Database. PATIENTS: Adult nontraumatic cardiac arrest patients in the emergency department, who survived to admission. INTERVENTIONS: These patients were classified into the steroid and nonsteroid groups based on whether steroid was used or not during hospitalization. A propensity score was used to match patient underlying characteristics, steroid use prior to cardiac arrest, the vasopressors, and shockable rhythm during cardiopulmonary resuscitation, hospital level, and socioeconomic status. MEASUREMENTS AND MAIN RESULTS: There were 5,445 patients in each group after propensity score matching. A total of 4,119 patients (75.65{\%}) in the steroid group died during hospitalization, as compared with 4,403 patients (80.86{\%}) in the nonsteroid group (adjusted hazard ratio, 0.74; 95{\%} CI, 0.70-0.77; p < 0.0001). The mortality rate at 1 year was significantly lower in the steroid group than in the nonsteroid group (83.54{\%} vs 87.77{\%}; adjusted hazard ratio, 0.73; 95{\%} CI, 0.70-0.76; p < 0.0001). Steroid use during hospitalization was associated with survival to discharge, regardless of age, gender, underlying diseases (diabetes mellitus, chronic obstructive pulmonary disease, asthma), shockable rhythm, and steroid use prior to cardiac arrest. CONCLUSIONS: In this retrospective observational study, postarrest steroid use was associated with better survival to hospital discharge and 1-year survival.",
author = "Tsai, {Min Shan} and Chuang, {Po Ya} and Huang, {Chien Hua} and Tang, {Chao Hsiun} and Yu, {Ping Hsun} and Chang, {Wei Tien} and Chen, {Wen Jone}",
year = "2019",
month = "2",
day = "1",
doi = "10.1097/CCM.0000000000003468",
language = "English",
volume = "47",
pages = "167--175",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Postarrest Steroid Use May Improve Outcomes of Cardiac Arrest Survivors

AU - Tsai, Min Shan

AU - Chuang, Po Ya

AU - Huang, Chien Hua

AU - Tang, Chao Hsiun

AU - Yu, Ping Hsun

AU - Chang, Wei Tien

AU - Chen, Wen Jone

PY - 2019/2/1

Y1 - 2019/2/1

N2 - OBJECTIVES: To evaluate the ramifications of steroid use during postarrest care. DESIGN: Retrospective observational population-based study enrolled patients during years 2004-2011 with 1-year follow-up. SETTING: Taiwan National Health Insurance Research Database. PATIENTS: Adult nontraumatic cardiac arrest patients in the emergency department, who survived to admission. INTERVENTIONS: These patients were classified into the steroid and nonsteroid groups based on whether steroid was used or not during hospitalization. A propensity score was used to match patient underlying characteristics, steroid use prior to cardiac arrest, the vasopressors, and shockable rhythm during cardiopulmonary resuscitation, hospital level, and socioeconomic status. MEASUREMENTS AND MAIN RESULTS: There were 5,445 patients in each group after propensity score matching. A total of 4,119 patients (75.65%) in the steroid group died during hospitalization, as compared with 4,403 patients (80.86%) in the nonsteroid group (adjusted hazard ratio, 0.74; 95% CI, 0.70-0.77; p < 0.0001). The mortality rate at 1 year was significantly lower in the steroid group than in the nonsteroid group (83.54% vs 87.77%; adjusted hazard ratio, 0.73; 95% CI, 0.70-0.76; p < 0.0001). Steroid use during hospitalization was associated with survival to discharge, regardless of age, gender, underlying diseases (diabetes mellitus, chronic obstructive pulmonary disease, asthma), shockable rhythm, and steroid use prior to cardiac arrest. CONCLUSIONS: In this retrospective observational study, postarrest steroid use was associated with better survival to hospital discharge and 1-year survival.

AB - OBJECTIVES: To evaluate the ramifications of steroid use during postarrest care. DESIGN: Retrospective observational population-based study enrolled patients during years 2004-2011 with 1-year follow-up. SETTING: Taiwan National Health Insurance Research Database. PATIENTS: Adult nontraumatic cardiac arrest patients in the emergency department, who survived to admission. INTERVENTIONS: These patients were classified into the steroid and nonsteroid groups based on whether steroid was used or not during hospitalization. A propensity score was used to match patient underlying characteristics, steroid use prior to cardiac arrest, the vasopressors, and shockable rhythm during cardiopulmonary resuscitation, hospital level, and socioeconomic status. MEASUREMENTS AND MAIN RESULTS: There were 5,445 patients in each group after propensity score matching. A total of 4,119 patients (75.65%) in the steroid group died during hospitalization, as compared with 4,403 patients (80.86%) in the nonsteroid group (adjusted hazard ratio, 0.74; 95% CI, 0.70-0.77; p < 0.0001). The mortality rate at 1 year was significantly lower in the steroid group than in the nonsteroid group (83.54% vs 87.77%; adjusted hazard ratio, 0.73; 95% CI, 0.70-0.76; p < 0.0001). Steroid use during hospitalization was associated with survival to discharge, regardless of age, gender, underlying diseases (diabetes mellitus, chronic obstructive pulmonary disease, asthma), shockable rhythm, and steroid use prior to cardiac arrest. CONCLUSIONS: In this retrospective observational study, postarrest steroid use was associated with better survival to hospital discharge and 1-year survival.

UR - http://www.scopus.com/inward/record.url?scp=85060139409&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060139409&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000003468

DO - 10.1097/CCM.0000000000003468

M3 - Article

VL - 47

SP - 167

EP - 175

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 2

ER -