Predictors of in-hospital mortality in patients with left ventricular assist device
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ORIGINAL ARTICLE
Predictors of in-hospital mortality in patients with left ventricular assist device Karthik Gonuguntla 1 & Shivaraj Patil 1 & Richard Gregory Cowden 2 & Manish Kumar 3 & Chaitanya Rojulpote 4 & Abhijit Bhattaru 5 & John Glenn Tiu 6 & Peter Robinson 6 Received: 26 March 2020 / Accepted: 28 April 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background A left ventricular assist device (LVAD) is used to support patients with end-stage heart failure. Aims To examine the role of comorbidities and complications in predicting in-hospital mortality since the introduction of continuous flow (CF)-LVAD. Methods The Nationwide Inpatient Sample was queried from 2010 to 2014 using International Classification of Disease-9 code for LVAD among patients 18 years or older. The sample consisted of 2,359 patients (mean age = 55 ± 13.7 years, 76.8% men, 59.3% Caucasian). Results Comparative analysis revealed mortality did not differ from 2010 to 2014 (p = 0.653). Increases in comorbidities of atrial fibrillation, acute kidney injury, mechanical ventilation, body mass index ≥ 25, cerebrovascular disease, and mild liver disease were evidenced over the 5-year period (p values ≤ 0.049). Multivariate analysis showed that significant predictors of mortality were comorbid hemodialysis (AOR = 7.62, 95% CI [4.78, 12.27]), cerebrovascular disease (AOR = 5.38, 95% CI [3.49, 8.26]), mechanical ventilation (AOR = 3.83, 95% CI [2.84, 5.18]), mild liver disease (AOR = 1.96, 95% CI [1.38, 2.76]), and acute kidney injury (AOR = 1.62, 95% CI [1.16, 2.28]). Predictive complications included disseminated intravascular coagulation (AOR = 6.41, 95% CI [2.79, 6.84]), sepsis (AOR = 4.37, 95% CI [2.79, 6.84]), septic shock (AOR = 3.9, 95% CI [2.11, 7.59]), and gastrointestinal bleed (AOR = 1.81, 95% CI [1.11, 2.93]). Conclusions CF-LVADs have not reduced mortality, possibly due to utilization in patients with comorbid conditions. Future trials are necessary for improved patient selection and reduced post-procedural complications. Keywords End-stage heart failure . GI bleed . In-hospital mortality . NIS . Predictors . Sepsis Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11845-020-02246-y) contains supplementary material, which is available to authorized users. * Karthik Gonuguntla [email protected] 1
Department of Internal Medicine and Cardiology, Calhoun Cardiology Center University of Connecticut, Farmington, CT, USA
2
Department of Psychology, University of the Free State, Bloemfontein 9301, South Africa
3
Department of Geriatrics, University of Connecticut, Farmington, CT, USA
4
Department of Nuclear Cardiology & Cardiovascular Molecular Imaging, University of Pennsylvania, Philadelphia, Pennsylvania, USA
5
Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
6
Department of Cardiology, Calhoun Cardiology Center University of Connecticut, Farmington, CT, USA
Introduction Heart failure (HF) is a growing global pandemic. Currently, t
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