ODP062 Clinical Outcomes of Cardiogenic Shock Hospitalization Among Patients with Long-term Systemic Steroid Use
Authors: Kumi Dennis D , Ramirez Marcelo , Soon-shiong Raquel , Patel Birju , Nissan Ninos , Karki Sadichhya , Shrestha Prajwal 
Published: November 2022

Abstract

Background
Cardiogenic shock is a state of immense stress, and our innate human response depends on a robust metabolic, neuroendocrine, and immunologic reserves. Long term use of systemic corticosteroids takes its toll on all aspects of this mechanism. Knowledge of how this basic physiology translates into clinical outcomes is scarce among patients with cardiogenic shock. Our study sought to identify such effects. Method: A retrospective cohort study was designed using data obtained from the 2016 to 2018 combined National Inpatient Sample (NIS) database. Adult patients (age &gt;18) with principal admission diagnosis of cardiogenic shock were identified using the international diseases classification code, tenth revision (ICD-10), and separated into two cohorts based on whether they had a secondary diagnosis of long term systemic steroid use. Primary outcomes assessed were, mortality, length of stay (LOS) and total hospital charge. Secondary outcomes included rate of mechanical ventilation, mechanical circulatory support device use and cardiac arrest. Multivariate linear and logistic regressions were used to adjust for confounders.

Results
There was a total of 477,695 adult hospitalizations for cardiogenic shock, out of which 1. 06% had associated secondary diagnosis of long-term systemic steroid use. The presence of long-term systemic steroid use was associated with 15% increased odds of mortality, (36.63% vs 33.32%, AOR: 1.15, 95% CI: 1. 01 to 1.30, p: 0. 039). However, there was a significant reduction in both length of stay (LOS), (9.85 days vs 11.56 days, adjusted mean difference: -1.59 days, 95%CI: -2.41 days to - 0.77 days, p &lt; 0. 001) and total charge (178,624.8 USD vs 240,859.3 USD, adjusted difference of -55,719.4 USD, 95% CI: - 70,348. 0 to -41,090.8) among patient with long-term systemic steroid use compared to the other cohort. Similarly, there was significantly reduced odds of both the rate of mechanical circulatory support device utilization (15.43% vs 20.32%, AOR: 0.99, 95%CI: 0.62 to 0.77, p: 0. 001) and rate of cardiac arrest (7.22% vs 9.31%, AOR: 0.78, 95%CI: 0.61 to 0.98, p: 0. 035) among patients with long term systemic steroid use. There was no difference in the rate of mechanical ventilation between the two groups.

Conclusion
the presence of long-term systemic steroid use as a comorbidity during hospitalization for cardiogenic shock was associated with an increased mortality but a reduction of LOS, total hospital charge, mechanical circulatory support device utilization and cardiac arrest. One can only hypothesize that the antiparallel relationship between mortality and the other primary and secondary outcomes could be brought about by earlier discharge from hospital due to death, thus truncating further needs for hospitalization and other interventions. This crucial paradox needs further studies to ascertain.
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