Interaction of the diabetes mellitus and cardiac diseases on survival outcomes in out-of-hospital cardiac arrest

Abstract

Background Diabetes mellitus (DM) and cardiac disease (CD) both likely effect out-of-hospital cardiac arrest (OHCA) survival, but the effect of their relationship on survival outcomes is unclear. This study aims to investigate whether the association of DM and OHCA outcomes differ in patients with and without CD. Methods The study was conducted from the national cardiac arrest registry among OHCA patients who survived to hospital admission from 2009 to 2013. Clinical histories of DM and CD were abstracted from patient medical records. Multivariable logistic regression analysis with an interaction term (DM and CD) was performed to calculate adjusted odds ratios (AORs) for survival to discharge and good cerebral performance category 1 or 2 (good CPC). Results Among 7583 study-eligible patients, 2651 (34.96%) patients had been previously diagnosed as having DM where 639 (24.1%) diabetic and 753 (15.3%) nondiabetic patients had CD (P <.01). Diabetes mellitus was observed to have harmful effect on survival and good CPC (AORs, 0.84 [0.75-0.95] and 0.81 [0.67-0.97]), whereas CD had nonsignificant effect (AORs, 1.34 [1.17-1.54] and 1.14 [0.94-1.38]). Diabetes mellitus had a significant negative association with survival outcomes in patients with CD (AORs, 0.58 [0.45-0.74] for survival and 0.52 [0.36-0.75] for good CPC), whereas the association was nonsignificant in patients without CD (AORs, 0.93 [0.82-1.06] for survival and [0.76-1.14] for good CPC). Conclusion Diabetes mellitus had a significant negative association with survival to discharge and neurologic recovery among patients with CD, but the association was not significant in patients without CD.