Patients with Diabetes Have Decreased Survivability with Good Neurological Outcomes After Out of Hospital Cardiac Arrest Público

Abstract

Out of hospital cardiac arrest strikes as a fatal public health concern in South Korea as the estimated survivability is around 3%. While previous studies have identified health conditions that increase the risk for OHCA, there is limited understanding in predicting OHCA survivability with good neurological outcomes. This study aims to provide a scientific evidence of the association between diabetes and the probability of OHCA survival with good neurological outcomes.

Methods: This study is a retrospective cross-sectional observational study based on a nationwide cohort in South Korea. The study population includes 5,936 emergency medical services-assessed non-traumatic OHCA cases with known diabetes statuses from 2009 to 2012. Association was evaluated using a multivariate logistic regression model adjusting for age, gender, history of heart disease, and hypothermia.

Results: A total of 186 out of 1,940 (9.59%) diabetic patients survived to discharge with good neurological outcomes. Overall, we observed that having diabetes led to decreased probability of surviving OHCA with good neurological outcomes with distinctive difference in the magnitude of how diabetes plays a role between men and women as well as with history of heart disease. The adjusted OR measuring the effect of diabetes on survival with good neurological outcomes for male with history of heart disease was 0.32 (0.22-0.48, p-value <0.0001), for male without history of heart disease was 0.55 (0.34-0.89, p-value <0.0001), for female with history of heart disease was 0.60 (0.48-0.76, p-value 0.0152), and for female without history of heart disease was 1.03 (0.71-1.47, p-value 0.8919).

Conclusion: This study provides evidence of significant associations of diabetes and decreased OHCA survivability with good neurological outcomes where the association is greater in male and patients with heart disease. Given the findings, further epidemiologic research is required to better understand the association between pre-existing health conditions with neurological recovery after OHCA.

Table of Contents

Table of Contents

Introduction 1

Burden of Disease 1

Sudden Cardiac Arrest Risk Factors and Survivability 1

Diabetes 2

Study goal 4

Methods 5

Study Design 5

Participants 5

Data sources and measurement 5

Variables 6

Outcome measure 8

Missing Data 9

Statistical Methods 9

Results 10

Discussion 14

Reference 17

Tables and Figures 22

Figure 1. Selection process of the study population 22

Table 1. Basic characteristics of all EMS-assessed out of hospital cardiac arrest (OHCA) patients in South Korea, 2009-2012 23

Table 2. Unadjusted survival outcomes for all EMS-assessed out of hospital cardiac arrest (OHCA) patients in South Korea, 2009-2012 26

Table 3. Bivariate analysis between potential confounders and survivability with good neurological outcomes 27

Table 4. Stratified analysis of diabetes status and survival with good neurological outcomes controlling for potential confounders 29

Table 5. The effect of diabetes on survival to discharge with good neurological outcomes in EMS-assessed out of hospital cardiac arrest patients in South Korea, 2009-2012: multivariate logistic regression analysis 31

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	sudden cardiac arrest diabetes public health
Committee Chair / Thesis Advisor	McClellan, William, Emory University
Committee Members	Shin, Sang Do, Seoul National University
Partnering Agencies	Emory University schools, faculty or affiliated programs Non-US governmental agency (e.g., Minister of Health in Haiti) University, college or educational institution (other than Emory)

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