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Research ArticleOriginal Article
Open Access

Outcomes of cirrhotic patients admitted to the intensive care unit after a successful cardiac arrest resuscitation

Moayed N. Alkhlewi, Hasan M. Al-Dorzi, Farhan Z. Alenezi, Abdulrahman M. Farhat, Hani Tamim, Musharaf Sadat, Felwa Bin Humaid and Yaseen M. Arabi
Saudi Medical Journal December 2021, 42 (12) 1320-1324; DOI: https://doi.org/10.15537/smj.2021.42.12.20210478
Moayed N. Alkhlewi
From the Department of Emergency Medicine and Critical Care (Alkhlewi); from the Intensive Care Department (Al-Dorzi, Alanazi, Sadat, Bin Humaid, Arabi), King Abdulaziz Medical City, and from the Ministry of National Guard-Health Affairs; from the College of Medicine (Alkhlewi, Al-Dorzi, Alanazi, Sadat, Tamim, Arabi), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alkhlewi, Al-Dorzi, Alanazi, Farhat, Tamim, Sadat, Humaid, Arabi), Riyadh; from the Faculty of Medicine (Farhat), Sulaiman Alrajhi University, Qassim, Kingdom of Saudi Arabia; and from the Department of Internal Medicine (Tamim), American University of Beirut, Beirut, Lebanon.
MBBS
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Hasan M. Al-Dorzi
From the Department of Emergency Medicine and Critical Care (Alkhlewi); from the Intensive Care Department (Al-Dorzi, Alanazi, Sadat, Bin Humaid, Arabi), King Abdulaziz Medical City, and from the Ministry of National Guard-Health Affairs; from the College of Medicine (Alkhlewi, Al-Dorzi, Alanazi, Sadat, Tamim, Arabi), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alkhlewi, Al-Dorzi, Alanazi, Farhat, Tamim, Sadat, Humaid, Arabi), Riyadh; from the Faculty of Medicine (Farhat), Sulaiman Alrajhi University, Qassim, Kingdom of Saudi Arabia; and from the Department of Internal Medicine (Tamim), American University of Beirut, Beirut, Lebanon.
MD
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Farhan Z. Alenezi
From the Department of Emergency Medicine and Critical Care (Alkhlewi); from the Intensive Care Department (Al-Dorzi, Alanazi, Sadat, Bin Humaid, Arabi), King Abdulaziz Medical City, and from the Ministry of National Guard-Health Affairs; from the College of Medicine (Alkhlewi, Al-Dorzi, Alanazi, Sadat, Tamim, Arabi), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alkhlewi, Al-Dorzi, Alanazi, Farhat, Tamim, Sadat, Humaid, Arabi), Riyadh; from the Faculty of Medicine (Farhat), Sulaiman Alrajhi University, Qassim, Kingdom of Saudi Arabia; and from the Department of Internal Medicine (Tamim), American University of Beirut, Beirut, Lebanon.
MBBS
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Abdulrahman M. Farhat
From the Department of Emergency Medicine and Critical Care (Alkhlewi); from the Intensive Care Department (Al-Dorzi, Alanazi, Sadat, Bin Humaid, Arabi), King Abdulaziz Medical City, and from the Ministry of National Guard-Health Affairs; from the College of Medicine (Alkhlewi, Al-Dorzi, Alanazi, Sadat, Tamim, Arabi), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alkhlewi, Al-Dorzi, Alanazi, Farhat, Tamim, Sadat, Humaid, Arabi), Riyadh; from the Faculty of Medicine (Farhat), Sulaiman Alrajhi University, Qassim, Kingdom of Saudi Arabia; and from the Department of Internal Medicine (Tamim), American University of Beirut, Beirut, Lebanon.
MBBS
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Hani Tamim
From the Department of Emergency Medicine and Critical Care (Alkhlewi); from the Intensive Care Department (Al-Dorzi, Alanazi, Sadat, Bin Humaid, Arabi), King Abdulaziz Medical City, and from the Ministry of National Guard-Health Affairs; from the College of Medicine (Alkhlewi, Al-Dorzi, Alanazi, Sadat, Tamim, Arabi), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alkhlewi, Al-Dorzi, Alanazi, Farhat, Tamim, Sadat, Humaid, Arabi), Riyadh; from the Faculty of Medicine (Farhat), Sulaiman Alrajhi University, Qassim, Kingdom of Saudi Arabia; and from the Department of Internal Medicine (Tamim), American University of Beirut, Beirut, Lebanon.
PhD
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Musharaf Sadat
From the Department of Emergency Medicine and Critical Care (Alkhlewi); from the Intensive Care Department (Al-Dorzi, Alanazi, Sadat, Bin Humaid, Arabi), King Abdulaziz Medical City, and from the Ministry of National Guard-Health Affairs; from the College of Medicine (Alkhlewi, Al-Dorzi, Alanazi, Sadat, Tamim, Arabi), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alkhlewi, Al-Dorzi, Alanazi, Farhat, Tamim, Sadat, Humaid, Arabi), Riyadh; from the Faculty of Medicine (Farhat), Sulaiman Alrajhi University, Qassim, Kingdom of Saudi Arabia; and from the Department of Internal Medicine (Tamim), American University of Beirut, Beirut, Lebanon.
MBBS
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Felwa Bin Humaid
From the Department of Emergency Medicine and Critical Care (Alkhlewi); from the Intensive Care Department (Al-Dorzi, Alanazi, Sadat, Bin Humaid, Arabi), King Abdulaziz Medical City, and from the Ministry of National Guard-Health Affairs; from the College of Medicine (Alkhlewi, Al-Dorzi, Alanazi, Sadat, Tamim, Arabi), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alkhlewi, Al-Dorzi, Alanazi, Farhat, Tamim, Sadat, Humaid, Arabi), Riyadh; from the Faculty of Medicine (Farhat), Sulaiman Alrajhi University, Qassim, Kingdom of Saudi Arabia; and from the Department of Internal Medicine (Tamim), American University of Beirut, Beirut, Lebanon.
BSc
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Yaseen M. Arabi
From the Department of Emergency Medicine and Critical Care (Alkhlewi); from the Intensive Care Department (Al-Dorzi, Alanazi, Sadat, Bin Humaid, Arabi), King Abdulaziz Medical City, and from the Ministry of National Guard-Health Affairs; from the College of Medicine (Alkhlewi, Al-Dorzi, Alanazi, Sadat, Tamim, Arabi), King Saud bin Abdulaziz University for Health Sciences; from King Abdullah International Medical Research Center (Alkhlewi, Al-Dorzi, Alanazi, Farhat, Tamim, Sadat, Humaid, Arabi), Riyadh; from the Faculty of Medicine (Farhat), Sulaiman Alrajhi University, Qassim, Kingdom of Saudi Arabia; and from the Department of Internal Medicine (Tamim), American University of Beirut, Beirut, Lebanon.
MD, FCCP
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    Table 1

    - Comparison of baseline characteristics of cirrhotic patients admitted to the ICU after successful cardiac arrest resuscitation between non-survivors and survivors.

    VariableAllDiedSurvivedP-value
    n=76n=67n=9
    Age (yrs), median (Q1, Q3)64 (57, 73)64 (54, 73)67 (59, 72)0.625
    Male gender, n (%)45 (59)39 (58)6 (67)0.628
    Diabetes, n (%)36 (47)32 (48)4 (44)0.852
    Other chronic Diseases, n (%)
    Chronic respiratory11(15)8 (12)3 (33)0.087
    Chronic renal25 (32.9)23 (34.3)2 (22)0.468
    Immunocompromised7 (9)5 (8)2 (22)0.151
    Chronic cardiac17 (22.4)12 (17.9)5 (55.56)0.007
    GCS on ICU admission, median (Q1, Q3)3 (3, 8)3 (3, 7)10 (9, 15)0.0003
    Mechanical ventilation, n (%)73 (96)67 (100)6 (66.7)0.003
    Vasopressors, n (%)47 (62)42 (63)5 (56)0.679
    APACHE II, median (Q1, Q3)37 (28.5, 42)38 (30, 43)24 (15, 29)0.006
    Laboratory findings in the first 24 hours
    Bilirubin (µmol/L), median (Q1, Q3)63 (21, 162)65 (29, 191)17.5 (10.5, 26.5)0.008
    Creatinine (µmol/L), median (Q1, Q3)195.5 (131, 271)199 (141, 283)167 (74, 215)0.150
    Lactic acid mmol/L, median (Q1, Q3)5.8 (2.9, 10.1)6.4 (3.7, 11.5)2.9 (2, 4.7)0.032
    INR, median (Q1, Q3)1.7 (1.4, 2.7)1.75 (1.40, 2.70)1.5 (1.3, 2.2)0.715
    PaO2/Fio2 ratio, median (Q1, Q3)155 (79, 237)150 (74, 230)214 (128, 238)0.425
    • For categorical variables, Fisher’s exact test is used to calculate the p-value. For continuous variables, Mann-Whitney test is used to calculate the p-value. For all percentages, the denominator is the total number of subjects in the group.

    • APACHEII: Acute Physiology And Chronic Health Evaluation II, GCS: Glasgow coma score, INR: internal normalized ratio, PaO2/FiO2 ratio: the ratio of the partial pressure of oxygen to the fraction of inspired oxygen, Q1: first quartile, Q3: third quartile

    • View popup
    Table 2

    - Outcomes of cirrhotic patients admitted to the ICU after successful cardiac arrest resuscitation between non-survivors and survivors.

    VariableAllDiedSurvivedP-value
    n=76n=67n=9
    ICU LOS (days), median (Q1, Q3)2.2 (0.5, 9.3)1.8 (0.5, 9.2)3.5 (2.5, 14.3)0.181
    Hospital LOS (days), median (Q1, Q3)10 (4, 30)13 (3, 26)64 (7, 380)0.136
    Mechanical ventilation duration (days), median (Q1, Q3)3 (1, 10)3 (1, 9)2 (0, 17)0.771
    Tracheostomy, n (%)10 (13)7 (11)3 (33)0.057
    • The denominator is the total number of subjects in the group. For continuous variables, Mann-Whitney test is used to calculate the p-value. For categorical variables, Fisher’s exact test is used to calculate the p-value ICU: intensive care unit, LOS: length of stay, Q: quartile

    • View popup
    Table 3

    - Logistic regression analysis to identify independent predictors of in-hospital mortality among cirrhotic patients admitted to the intensive care unit after successful cardiac arrest resuscitation.

    VariablesOR95% CIP-value
    Age (per 1-year increase)0.990.93-1.060.830
    APACHE II (per 1-unit increase)1.211.06-1.380.005
    Bilirubin (per 1-unit increase)1.041.01-1.070.022
    Vasopressor13.690.62-301.910.097
    GCS0.660.50-0.880.005
    • GSC: Glasgow coma scale, OR: odds ratio, CI: confidence interval

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Saudi Medical Journal: 42 (12)
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Outcomes of cirrhotic patients admitted to the intensive care unit after a successful cardiac arrest resuscitation
Moayed N. Alkhlewi, Hasan M. Al-Dorzi, Farhan Z. Alenezi, Abdulrahman M. Farhat, Hani Tamim, Musharaf Sadat, Felwa Bin Humaid, Yaseen M. Arabi
Saudi Medical Journal Dec 2021, 42 (12) 1320-1324; DOI: 10.15537/smj.2021.42.12.20210478

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Outcomes of cirrhotic patients admitted to the intensive care unit after a successful cardiac arrest resuscitation
Moayed N. Alkhlewi, Hasan M. Al-Dorzi, Farhan Z. Alenezi, Abdulrahman M. Farhat, Hani Tamim, Musharaf Sadat, Felwa Bin Humaid, Yaseen M. Arabi
Saudi Medical Journal Dec 2021, 42 (12) 1320-1324; DOI: 10.15537/smj.2021.42.12.20210478
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Keywords

  • cirrhosis
  • ICU
  • outcome
  • cardiac arrest
  • successful resuscitation

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