Karlsson Viktor, Dankiewicz Josef, Nielsen Niklas, Kern Karl B, Mooney Michael R, Riker Richard R, Rubertsson Sten, Seder David B, Stammet Pascal, Sunde Kjetil, Søreide Eldar, Unger Barbara T, Friberg Hans
Department of Clinical Sciences, Lund University, 22184, Lund, Sweden.
Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Lund, 22185, Sweden.
Crit Care. 2015 Apr 21;19(1):182. doi: 10.1186/s13054-015-0904-y.
Previous studies have suggested an effect of gender on outcome after out-of-hospital cardiac arrest (OHCA), but the results are conflicting. We aimed to investigate the association of gender to outcome, coronary angiography (CAG) and adverse events in OHCA survivors treated with mild induced hypothermia (MIH).
We performed a retrospective analysis of prospectively collected data from the International Cardiac Arrest Registry. Adult patients with a non-traumatic OHCA and treated with MIH were included. Good neurological outcome was defined as a cerebral performance category (CPC) of 1 or 2.
A total of 1,667 patients, 472 women (28%) and 1,195 men (72%), met the inclusion criteria. Men were more likely to receive bystander cardiopulmonary resuscitation, have an initial shockable rhythm and to have a presumed cardiac cause of arrest. At hospital discharge, men had a higher survival rate (52% vs. 38%, P < 0.001) and more often a good neurological outcome (43% vs. 32%, P < 0.001) in the univariate analysis. When adjusting for baseline characteristics, male gender was associated with improved survival (OR 1.34, 95% CI 1.01 to 1.78) but no longer with neurological outcome (OR 1.24, 95% CI 0.92 to 1.67). Adverse events were common; women more often had hypokalemia, hypomagnesemia and bleeding requiring transfusion, while men had more pneumonia. In a subgroup analysis of patients with a presumed cardiac cause of arrest (n = 1,361), men more often had CAG performed on admission (58% vs. 50%, P = 0.02) but this discrepancy disappeared in an adjusted analysis.
Gender differences exist regarding cause of arrest, adverse events and outcome. Male gender was independently associated with survival but not with neurological outcome.
先前的研究表明性别对院外心脏骤停（OHCA）后的结局有影响，但结果相互矛盾。我们旨在调查性别与接受轻度亚低温治疗（MIH）的OHCA幸存者的结局、冠状动脉造影（CAG）及不良事件之间的关联。
我们对国际心脏骤停登记处前瞻性收集的数据进行了回顾性分析。纳入成年非创伤性OHCA且接受MIH治疗的患者。良好的神经学结局定义为脑功能分类（CPC）为1或2。
共有1667例患者符合纳入标准，其中472例女性（28%），1195例男性（72%）。男性更有可能接受旁观者心肺复苏，初始心律可电击复律，且心脏骤停原因更可能为心脏源性。在单因素分析中，男性在出院时生存率更高（52%对38%，P<0.001），神经学结局良好的比例也更高（43%对32%，P<0.001）。在对基线特征进行校正后，男性性别与生存率提高相关（OR 1.34，95%CI 1.01至1.78），但与神经学结局不再相关（OR 1.24，95%CI 0.92至1.67）。不良事件很常见；女性更常出现低钾血症、低镁血症和需要输血的出血，而男性肺炎更多。在心脏骤停原因推测为心脏源性的患者亚组分析中（n = 1361），男性入院时接受CAG检查的比例更高（58%对50%，P = 0.02），但在校正分析中这种差异消失。
在心脏骤停原因、不良事件和结局方面存在性别差异。男性性别与生存率独立相关，但与神经学结局无关。
