Tien-Chan Hsieh, MD1, Guangchen Zou, MD1, Gin Yi Lee, MD1, Kaiqing Lin, MD1, Yee Hui Yeo, MD2 1Danbury Hospital, Danbury, CT; 2Cedars-Sinai Medical Center, Los Angeles, CA
Introduction: The prognosis of in-hospital cardiopulmonary resuscitation (ICPR) in cancer patients was worse than general population. Certain cancer types were also identified as independent poor prognostic factor. We aim to investigate the impact of colorectal cancer (CRC), the third most common cancer, in the outcomes of ICPR, which is relatively unknown.
Methods: This is a retrospective analysis of National Inpatient Sample database (2016-2018) including adult admissions with ICPR. Patients with ICPR and CRC were defined by International Classification of Diseases, 10th Revision. Multivariable logistic regression was performed to determine the CRC-associated variables.
Results: A total of 67,351 adult ICPR-associated hospitalizations were identified. Among them, 7,008 had at least one cancer diagnosis of which 13.3% (n = 929) had CRC. The mortality risk of admissions with CRC was higher than that of non-CRC patients (82.2% vs 68.6%, adjusted odds ratio [aOR]: 1.69, p < 0.0001). CRC patients were younger, with more comorbidities (higher Charlson Comorbidity Index), higher risk of severe sepsis, less likely to be intubated, and higher palliative care utility (Figure 1). Among hospitalizations with cancer diagnosis, CRC subgroup had borderline significant trend of higher mortality (aOR: 1.13, p < 0.1) and significantly higher risk of severe sepsis (aOR: 1.26, p < 0.001). Utilization of palliative care was similar between CRC and non-CRC cancer cases (p > 0.8). Urban teaching hospitals have a trend of higher palliative care utility than rural hospitals in CRC with ICPR (aOR: 2.84, p < 0.1). The total charges and length of stay were lower in CRC patients but not statistically different.
Discussion: ICPR in CRC-associated hospitalization had significantly higher mortality rate. Among cancer patients, CRC subgroup also had an unfavorable trend of higher mortality risk. Higher risk of severe sepsis could possibly lead to less favorable ICPR outcomes of CRC. The association of severe sepsis and CRC after ICPR is still unknown and requires further analysis. CRC patients with ICPR are more likely to receive palliative care, which may depend on the availability of hospital resources. The clinicians, patients, and the health care surrogates should understand the poor ICPR prognosis in CRC when discussing the code status and goal of care.
Figure: Figure 1. Forest plot of multivariate regression analysis for odds of having CRC. The x-axis is odds ratio (solid dot) with the reference line and 95% confidence interval (whiskers).
Tien-Chan Hsieh indicated no relevant financial relationships.
Guangchen Zou indicated no relevant financial relationships.
Gin Yi Lee indicated no relevant financial relationships.
Kaiqing Lin indicated no relevant financial relationships.
Yee Hui Yeo indicated no relevant financial relationships.
Tien-Chan Hsieh, MD1, Guangchen Zou, MD1, Gin Yi Lee, MD1, Kaiqing Lin, MD1, Yee Hui Yeo, MD2. P0125 - Higher Mortality and Risk of Severe Sepsis in Colorectal Cancer Patients After In-Hospital Cardiopulmonary Resuscitation – A Nationwide Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.