Outcomes of Patients with Cirrhosis Undergoing Cardiac Defibrillator Placement: A Nationwide Analysis

Background Invasive procedures pose a greater risk for patients with liver cirrhosis. This study investigates the impact of cirrhosis on the outcomes of implantable cardiac defibrillator (ICD) implantation. Methods We conducted a retrospective analysis using the National Readmissions Database (NRD) from 2016 to 2020. Adult patients who received an ICD, identified by the International Statistical Classification of Diseases and Related Health Problems 10^th Revision (ICD-10) codes, were included. Outcomes were compared between patients with and without underlying liver cirrhosis. The primary outcome was all-cause inpatient mortality. Secondary outcomes included ischemic cerebrovascular accidents (CVA), major bleeding (gastrointestinal, intracranial, pulmonary, and other bleeding), packed red blood cell (pRBC) transfusion, pericardial complications (pericardial effusion, hemopericardium, or pericardial tamponade), acute kidney injury (AKI), acute myocardial infarction (AMI), length of stay, and total hospital charges. Results Among 264,518 patients who underwent defibrillator implantation, 3,507 patients (1.3%) had liver cirrhosis. Patients with cirrhosis experienced significantly higher inpatient mortality (adjusted odds ratio (aOR): 2.29, 95% confidence interval (CI): 1.70-3.08, P<0.001), major bleeding (aOR: 2.40, 95% CI: 1.97-2.91, P<0.001), pRBC transfusion (aOR: 2.19, 95% CI: 1.81-2.64, P<0.001), pericardial complications (aOR: 1.37, 95% CI: 1.05-1.79, P=0.02), and AKI (aOR: 1.44, 95% CI: 1.29-1.59, P<0.001). No significant difference was observed in the incidence of ischemic CVA (aOR: 0.89, 95% CI: 0.33-2.43, p=0.83), but there was a reduced incidence of AMI (aOR: 0.69, 95% CI: 0.59-0.84, P<0.001) in patients with cirrhosis. Additionally, liver cirrhosis was associated with increased hospital stays (adjusted mean difference (aMD): 2.79 days, 95% CI: 2.20-3.37, P<0.001) and higher total charges (aMD: $35,624, 95% CI: 23,698-47,549, P<0.001). Conclusion Cirrhosis is associated with increased mortality, bleeding complications, and greater resource utilization after ICD implantation. These results emphasize the need for careful evaluation when considering this procedure in patients with liver cirrhosis.